Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0800X | Contact Lens | ||
Y | 156FX1700X | Ocularist |
NPI | 1306044631 |
---|---|
Provider Name | Mrs. Lavon Hinshaw Drake |
First Address | Washington, NC 27889-7606 |
Second Address | Wilmington, NC 28405-2145 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2007 |
Last Update Date | 09/07/2007 |