Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | D2189 | NJ |
NPI | 1124246202 |
---|---|
Provider Name | Mrs. Sally Ann Fokas |
First Address | Montclair, NJ 07043-1880 |
Second Address | Montclair, NJ 07043-1880 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 15/02/2008 |