Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1960 | NC |
NPI | 1124327093 |
---|---|
Provider Name | Mr. Matthew Edwin Libby |
First Address | Durham, NC 27701-3059 |
Second Address | Durham, NC 27701-3059 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2011 |
Last Update Date | 17/03/2011 |