Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | S. 7050 | OH |
NPI | 1184775587 |
---|---|
Provider Name | Mrs. Kelli Suzanne Lewis |
First Address | Huntington, WV 25701-2902 |
Second Address | Huntington, WV 25701-2902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2007 |
Last Update Date | 27/06/2008 |