Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FC0801X | Contact Lens Fitter | 3987 | NY |
NPI | 1205961778 |
---|---|
Provider Name | Mr. William Henry Luce |
First Address | West Islip, NY 11795-3115 |
Second Address | West Islip, NY 11795-3115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2007 |
Last Update Date | 08/07/2007 |