Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO 1387 | FL |
NPI | 1053425488 |
---|---|
Provider Name | Mr. Richard William Bergida |
First Address | Delray Beach, FL 33483-3329 |
Second Address | Delray Beach, FL 33483-3329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 25/06/2008 |