Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 3364 | NY |
NPI | 1215096227 |
---|---|
Provider Name | Mr. Richard James Witt |
First Address | Buffalo, NY 14212-1218 |
Second Address | Buffalo, NY 14212-1218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01208731 | (05) | NY |