Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 005319-1 | NY |
NPI | 1073803565 |
---|---|
Provider Name | Mr. Steven P Jannen |
First Address | Camillus, NY 13031-1414 |
Second Address | Syracuse, NY 13215-2261 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2011 |
Last Update Date | 18/04/2011 |