Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO 2506 | FL |
NPI | 1205954682 |
---|---|
Provider Name | Mr. Roger Halphen |
First Address | Miami Springs, FL 33166-5219 |
Second Address | Miami Springs, FL 33166-5219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 08/07/2007 |