Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 4719 | MA |
N | 156FX1800X | Optician | OP00285 | RI |
NPI | 1073726618 |
---|---|
Provider Name | Patricia Ann Horan |
First Address | North Dartmouth, MA 02747-3319 |
Second Address | North Dartmouth, MA 02747-3319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 08/07/2007 |