Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 156FX1800X | PA |
NPI | 1003039496 |
---|---|
Provider Name | Mr. Raymond P Roslonski |
First Address | Pittsburgh, PA 15203-1228 |
Second Address | Pittsburgh, PA 15203-1228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 10/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MA081009 | (05) | PA |