Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | 26392 | IA |
NPI | 1093701989 |
---|---|
Provider Name | Mr. Yadolah Karnama |
First Address | West Burlington, IA 52655-1693 |
Second Address | West Burlington, IA 52655-1693 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2005 |
Last Update Date | 04/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0258343 | (05) | IA |
A03587 | (02) |