Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO4171 | FL |
NPI | 1235359258 |
---|---|
Provider Name | Mrs. Sherri Alaine Cole |
First Address | Lake City, FL 32025-6841 |
Second Address | Lake City, FL 32025-4240 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
630349800 | (05) | FL |