Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist | WI |
NPI | 1407283955 |
---|---|
Provider Name | Ms. Dori K. Hosek |
First Address | Madison, WI 53705-2288 |
Second Address | Madison, WI 53705-2288 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2013 |
Last Update Date | 30/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
41744100 | (05) | WI |