Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | NY5219 | NY |
NPI | 1083773915 |
---|---|
Provider Name | Mrs. Dana L Vallas |
First Address | Hamburg, NY 14075 |
Second Address | Hamburg, NY 14075 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 18/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0183660001 | (02) | NY |