Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1114392941 |
---|---|
Provider Name | Ms. Lori A Brown |
First Address | San Antonio, TX 78254-2303 |
Second Address | Mcminnville, OR 97128-2723 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2015 |
Last Update Date | 04/12/2015 |