Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist | FL |
NPI | 1508294117 |
---|---|
Provider Name | Mr. Nicholas R Urdiales |
First Address | Corinth, TX 76208-5373 |
Second Address | Bradenton, FL 34211-4906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2013 |
Last Update Date | 16/10/2013 |