Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 14551 | CA |
NPI | 1013260066 |
---|---|
Provider Name | Niko Olavi Vahamaki |
First Address | Ridgeland, SC 29936-8008 |
Second Address | Beaufort, SC 29902-6122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2012 |
Last Update Date | 16/10/2012 |