Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 44006 | DE |
NPI | 1063687002 |
---|---|
Provider Name | Mr. Ralph Peter Rubeo |
First Address | Wilmington, DE 19801-3053 |
Second Address | Wilmington, DE 19801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2008 |
Last Update Date | 29/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000883622 | (05) | DE |