Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1215175625 |
---|---|
Provider Name | Mrs. Pamela A Tefft |
First Address | Newburgh, IN 47630-2532 |
Second Address | Newburgh, IN 47630-2532 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2009 |
Last Update Date | 23/01/2009 |