Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0801X | Contact Lens Fitter | C6690-1 | NY |
Y | 156FX1800X | Optician | C6690-1 | NY |
NPI | 1902039159 |
---|---|
Provider Name | Mr. Mark Mastro |
First Address | Rochester, NY 14609-4241 |
Second Address | Rochester, NY 14609-4241 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2009 |
Last Update Date | 03/09/2009 |