Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO2188 | FL |
NPI | 1205006483 |
---|---|
Provider Name | Ralph Reichert |
First Address | Venice, FL 34293-3142 |
Second Address | Venice, FL 34293-3142 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2008 |
Last Update Date | 04/03/2008 |