Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0801X | Contact Lens Fitter | NH0457 | NH |
Y | 156FX1800X | Optician | NH0457 | NH |
NPI | 1093940686 |
---|---|
Provider Name | Mrs. Sonja Patricia Carleton |
First Address | Newport, NH 03773-0148 |
Second Address | Newport, NH 03773-1519 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2009 |
Last Update Date | 13/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1017998 | (05) | VT |
30757583 | (05) | NH |