Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 31TD00228400 | NJ |
NPI | 1114145315 |
---|---|
Provider Name | Ms. Sandra Farner |
First Address | Manahawkin, NJ 08050-2414 |
Second Address | Manahawkin, NJ 08050-2414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 08/07/2007 |