Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 5113 | NY |
NPI | 1225161318 |
---|---|
Provider Name | Mrs. Tina Terese Brown-Carter |
First Address | Rochester, NY 14610-0494 |
Second Address | East Rochester, NY 14445-1315 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 05/12/2013 |