Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1104487305 |
---|---|
Provider Name | Mr. Robert J Schaefer JR. |
First Address | Buffalo, NY 14226-4707 |
Second Address | Buffalo, NY 14226-4707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2019 |
Last Update Date | 27/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
156FX1800X | OPTICIAN (01) | NY |