Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0800X | Contact Lens | B4624 | CA |
N | 156FX1800X | Optician | 43911 | CA |
NPI | 1063571008 |
---|---|
Provider Name | Mrs. Lyudmila Proektor |
First Address | West Hollywood, CA 90046-6325 |
Second Address | Los Angeles, CA 90036-3155 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DX006939F | (05) | CA |