Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1023560893 |
---|---|
Provider Name | Ms. Phyliss D Scott |
First Address | Anniston, AL 36207-5786 |
Second Address | Anniston, AL 36207-5786 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2016 |
Last Update Date | 27/10/2016 |