Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1043326085 |
---|---|
Provider Name | Mr. Patrick Raymond Buczkowski |
First Address | Happy Valley, OR 97086-4707 |
Second Address | Happy Valley, OR 97086-4707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 05/02/2008 |