Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FX1800X | Optician | 5703 | MA |
Y | 156FX1800X | Optician | OP 00334 | RI |
NPI | 1235356908 |
---|---|
Provider Name | Mr. Maroun Adib Komari |
First Address | Cranston, RI 02920-6060 |
Second Address | Cranston, RI 02920-6060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 26/11/2012 |