Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 4337-1 | NY |
NPI | 1114136652 |
---|---|
Provider Name | Ms. Diane Marie Terranova |
First Address | Lancaster, NY 14086-9300 |
Second Address | Lancaster, NY 14086-9300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |