Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 633 | NV |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OEG002150 | PA |
NPI | 1033362074 |
---|---|
Provider Name | Mr. Timothy J O'shea |
First Address | Sparks, NV 89436-7703 |
Second Address | Sparks, NV 89436-7703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2008 |
Last Update Date | 03/11/2008 |