Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1108 | KY |
NPI | 1194001859 |
---|---|
Provider Name | Mrs. Diane H. Mando |
First Address | Crestview Hills, KY 41017-2176 |
Second Address | Crestview Hills, KY 41017-2176 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2011 |
Last Update Date | 26/10/2011 |