Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | OE702 | FL |
NPI | 1093907784 |
---|---|
Provider Name | Mr. Stephen Mason |
First Address | Port Charlotte, FL 33980-2152 |
Second Address | Port Charlotte, FL 33980-2152 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2007 |
Last Update Date | 22/10/2007 |