Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 6000000546 | PA |
NPI | 1093914814 |
---|---|
Provider Name | Mr. Raymond Joseph Miske JR. |
First Address | Port Carbon, PA 17965-1814 |
Second Address | Port Carbon, PA 17965-1814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2007 |
Last Update Date | 12/07/2007 |