Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPC5241 | FL |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OPC2541 | FL |
NPI | 1346690526 |
---|---|
Provider Name | Ms. Samantha J Rao |
First Address | Davie, FL 33329-0370 |
Second Address | Davie, FL 33328-2018 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2016 |
Last Update Date | 21/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
018498500 | (05) | FL |