Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 26981ABOC | NE |
NPI | 1184849077 |
---|---|
Provider Name | Mr. William B Athey |
First Address | Kearney, NE 68845-1288 |
Second Address | Kearney, NE 68845-1288 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2007 |
Last Update Date | 28/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10025321800 | (05) | NE |