Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 509 | SC |
NPI | 1275608499 |
---|---|
Provider Name | Norris Rick Philbeck |
First Address | Mount Pleasant, SC 29429-4966 |
Second Address | Mc Clellanville, SC 29458-9422 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 28/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AA6871 | (02) | SC |
D05091 | (05) | SC |