Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 007233-1 | NY |
NPI | 1063728889 |
---|---|
Provider Name | Mrs. Lisa Lynn Dolezel |
First Address | Oneonta, NY 13820-2266 |
Second Address | Oneonta, NY 13820-2266 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2010 |
Last Update Date | 31/08/2010 |