Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 753 | NC |
NPI | 1093912560 |
---|---|
Provider Name | Mrs. Virginia S Hayes |
First Address | Clarkton, NC 28433-8705 |
Second Address | Elizabethtown, NC 28337-8845 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8801930 | (05) | NC |