Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist | DR3217-DR3216 | TX |
NPI | 1548312242 |
---|---|
Provider Name | Mr. Vernon Randolph Lamb |
First Address | San Angelo, TX 76902 |
Second Address | San Angelo, TX 76903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 03/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000P9202 | (05) | NM |