Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1271 | MA |
NPI | 1053854893 |
---|---|
Provider Name | Mr. Wayne Paddock |
First Address | Hyannis, MA 02601-1929 |
Second Address | Hyannis, MA 02601-1929 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2016 |
Last Update Date | 28/11/2016 |