Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 006398 | NY |
NPI | 1043649932 |
---|---|
Provider Name | Mrs. Wendy Sue Micca |
First Address | Webster, NY 14580 |
Second Address | Rochester, NY 14620-1103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2013 |
Last Update Date | 01/11/2013 |