Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 471 | NC |
NPI | 1235286360 |
---|---|
Provider Name | Mrs. Sonja Ann Osborne |
First Address | Lewisville, NC 27023-9627 |
Second Address | Winston Salem, NC 27103-3031 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8802014 | (05) | NC |