Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | S6592 | OH |
NPI | 1043376908 |
---|---|
Provider Name | Mr. Richard B Leffe |
First Address | Wheeling, WV 26003 |
Second Address | Wheeling, WV 26003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0151827000 | (05) | WV |