Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | NOT APPLICABLE IN PA | PA |
NPI | 1023035607 |
---|---|
Provider Name | Mr. Richard G Weiss |
First Address | Ephrata, PA 17522-2720 |
Second Address | York, PA 17402-9501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 08/07/2007 |