Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist | 1508 | LA |
NPI | 1649433475 |
---|---|
Provider Name | Mr. Richard Charles Abda |
First Address | Kenner, LA 70062-4103 |
Second Address | Kenner, LA 70062-4103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2008 |
Last Update Date | 02/07/2008 |