Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FC0801X | Contact Lens Fitter | 224771 | TX |
NPI | 1396283545 |
---|---|
Provider Name | Mr. Santiago Sergio Garcia |
First Address | Laredo, TX 78041-6903 |
Second Address | Laredo, TX 78041-6903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2017 |
Last Update Date | 08/02/2017 |