Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FC0800X | Contact Lens |
NPI | 1063851822 |
---|---|
Provider Name | Mr. Titus Snell |
First Address | Clinton, MS 39060-0923 |
Second Address | Clinton, MS 39056-3509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2013 |
Last Update Date | 14/06/2013 |