Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 716 | SC |
NPI | 1093993321 |
---|---|
Provider Name | Mrs. Barbara B Brown |
First Address | Camden, SC 29020-3523 |
Second Address | Camden, SC 29020-3523 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2008 |
Last Update Date | 08/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DV7163 | (05) | SC |