Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1101X | Ophthalmic Assistant | NONE REQUIRED | OH |
NPI | 1528264801 |
---|---|
Provider Name | Mr. Mario A. Delisio JR. |
First Address | Willoughby, OH 44094-4373 |
Second Address | Mayfield Hts, OH 44124-2299 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2007 |
Last Update Date | 08/07/2007 |