Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1124357868 |
---|---|
Provider Name | Ralph Bradeley Charles |
First Address | Miami, FL 33168-3030 |
Second Address | Miami, FL 33168-3030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2009 |
Last Update Date | 08/12/2009 |