Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1215233804 |
---|---|
Provider Name | Mr. William L Burdeaux |
First Address | Dover, DE 19901-4956 |
Second Address | Dover, DE 19901-4956 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2011 |
Last Update Date | 31/01/2011 |