Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 1605 | NC |
NPI | 1336105766 |
---|---|
Provider Name | Mr. Paul T Rock |
First Address | Edenton, NC 27932-1077 |
Second Address | Nags Head, NC 27959 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 03/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0978A | BC (01) | |
890978A | (05) | NC |
U06032 | (02) |