Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0801X | Contact Lens Fitter | 5313C | NY |
Y | 156FX1800X | Optician | 5313C | NY |
NPI | 1164545174 |
---|---|
Provider Name | Mr. Thomas Christian Foote |
First Address | Java Center, NY 14082-0165 |
Second Address | Arcade, NY 14009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 23/07/2008 |