Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | KY-1293 | KY |
NPI | 1154577864 |
---|---|
Provider Name | Ms. Rhonda Lynn Martin |
First Address | Mt. Sterling, KY 40353 |
Second Address | Mt. Sterling, KY 40353 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2008 |
Last Update Date | 29/09/2008 |