Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1114117819 |
---|---|
Provider Name | Mrs. Adda O Medina |
First Address | Dallas, TX 75234-7764 |
Second Address | Dallas, TX 75234-7764 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2007 |
Last Update Date | 28/07/2007 |