Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | C005574 | NY |
NPI | 1063640449 |
---|---|
Provider Name | Mrs. Joanne Patricia Murray |
First Address | Medina, NY 14103-1417 |
Second Address | Medina, NY 14103-1417 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2009 |
Last Update Date | 24/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02604864 | (05) | NY |