Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 212 | RI |
NPI | 1164830675 |
---|---|
Provider Name | Mrs. Kim J. Chace |
First Address | East Greenwich, RI 02818-3400 |
Second Address | East Greenwich, RI 02818-3400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2014 |
Last Update Date | 28/07/2014 |