Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1297 | FL |
NPI | 1053616201 |
---|---|
Provider Name | Mr. Vaughn Rae Meiners |
First Address | St Petersburg, FL 33714-3722 |
Second Address | St Petersburg, FL 33714-3722 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2011 |
Last Update Date | 19/01/2011 |