Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1023119559 |
---|---|
Provider Name | Mrs. Barbara Scott |
First Address | Winnetka, IL 60093-2201 |
Second Address | Winnetka, IL 60093-2201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 20/05/2008 |