Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | CO |
NPI | 1134274558 |
---|---|
Provider Name | Mr. Steve S Bagga |
First Address | Grand Junction, CO 81501-6419 |
Second Address | Grand Junction, CO 81501-6419 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 08/07/2007 |