Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1991073141 | DE |
NPI | 1104998723 |
---|---|
Provider Name | Mr. Robert Hazen |
First Address | Wilmington, DE 19808-1928 |
Second Address | Wilmington, DE 19808-1928 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 09/07/2007 |