Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | PA |
NPI | 1184611360 |
---|---|
Provider Name | Mr. Michael F Novotny |
First Address | St Marys, PA 15857-2830 |
Second Address | St Marys, PA 15857-2830 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2005 |
Last Update Date | 08/07/2007 |