Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1842 | MA |
NPI | 1174659155 |
---|---|
Provider Name | Mr. Thomas Joseph Miner |
First Address | Shelburne Falls, MA 01370-1102 |
Second Address | Shelburne Falls, MA 01370-1102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1537288 | (05) | MA |