Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1101000478 | VA |
NPI | 1205072519 |
---|---|
Provider Name | Mr. Warren A Wittig |
First Address | Mount Jackson, VA 22842-2862 |
Second Address | Mount Jackson, VA 22842-2862 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2008 |
Last Update Date | 17/12/2008 |