Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | L-8802 | AR |
NPI | 1235378589 |
---|---|
Provider Name | Mrs. Zoella Kay Rogers |
First Address | Fort Smith, AR 72903-2033 |
Second Address | Fort Smith, AR 72903-2033 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2009 |
Last Update Date | 10/02/2009 |