Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 6000000836 | PA |
NPI | 1184010134 |
---|---|
Provider Name | Mr. Terrence Edward Salek |
First Address | Swoyersville, PA 18704-1318 |
Second Address | Swoyersville, PA 18704-1318 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2015 |
Last Update Date | 12/04/2015 |