Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | D 3439 | CA |
NPI | 1043438666 |
---|---|
Provider Name | Mr. Mark David Handmacher |
First Address | San Diego, CA 92103 |
Second Address | San Diego, CA 92103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 18/12/2008 |