Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 4025 | NY |
NPI | 1205977493 |
---|---|
Provider Name | Mr. Raymond Kolkmann |
First Address | Mahopac, NY 10541-2521 |
Second Address | Yonkers, NY 10710-5704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2007 |
Last Update Date | 08/07/2007 |