Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1215304894 |
---|---|
Provider Name | Mrs. Shaunda Leigh Adams |
First Address | Olathe, KS 66061-4133 |
Second Address | Olathe, KS 66061-4133 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2015 |
Last Update Date | 30/08/2015 |