Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 046.011000 | IL |
NPI | 1013365188 |
---|---|
Provider Name | Natalie Wozny |
First Address | Chicago, IL 60654-7209 |
Second Address | Chicago, IL 60654-7209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2016 |
Last Update Date | 27/02/2017 |