Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1063699700 |
---|---|
Provider Name | Mr. Odell Artto Smith JR. |
First Address | Baltimore, MD 21201-4648 |
Second Address | Baltimore, MD 21201-4648 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2008 |
Last Update Date | 24/01/2008 |