Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist |
NPI | 1881800100 |
---|---|
Provider Name | Mrs. Susan A Shore |
First Address | Moorestown, NJ 08057-2345 |
Second Address | Moorestown, NJ 08057-2345 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 12/11/2007 |