Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1093046898 |
---|---|
Provider Name | Mr. Lucas Lopez |
First Address | Milwaukee, WI 53212-3049 |
Second Address | Milwaukee, WI 53212-3049 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2010 |
Last Update Date | 19/01/2010 |