Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 11610T | CA |
N | 156FX1700X | Ocularist | 11610T | CA |
NPI | 1396767687 |
---|---|
Provider Name | Mr. Noah Dan Brinley |
First Address | Long Beach, CA 90802-4804 |
Second Address | Long Beach, CA 90802-4804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 26/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U88965 | (02) |