Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 001684 | GA |
NPI | 1205132552 |
---|---|
Provider Name | Mr. Robert S. Na |
First Address | Suwanee, GA 30024-6856 |
Second Address | Suwanee, GA 30024-6856 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2011 |
Last Update Date | 13/03/2012 |