Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 5558 | FL |
NPI | 1154821478 |
---|---|
Provider Name | Mr. Ronald Catterson |
First Address | The Villages, FL 32162-5847 |
Second Address | The Villages, FL 32162-5847 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2018 |
Last Update Date | 13/02/2018 |