Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1402 | FL |
NPI | 1093849259 |
---|---|
Provider Name | Mr. Shawn Carson |
First Address | Brandon, FL 33511-5722 |
Second Address | Brandon, FL 33511-5722 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2007 |
Last Update Date | 25/04/2008 |