Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FC0801X | Contact Lens Fitter | ||
N | 156FX1800X | Optician |
NPI | 1447403266 |
---|---|
Provider Name | Mr. Mark Flynt Cloer SR. |
First Address | Madison, MS 39110-9612 |
Second Address | Madison, MS 39110-9612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2008 |
Last Update Date | 23/10/2008 |