Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DR3962 | TX |
NPI | 1013050319 |
---|---|
Provider Name | Mrs. Janice Kay Faulkner |
First Address | Fort Worth, TX 76104 |
Second Address | Fort Worth, TX 76104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 01/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
066429401 | (05) | TX |