Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 030-0129293 | VT |
N | 152W00000X | Optometrist | OEG003147 | PA |
NPI | 1003267428 |
---|---|
Provider Name | Ran He |
First Address | White River Junction, VT 05001-8031 |
Second Address | White River Junction, VT 05001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2016 |
Last Update Date | 13/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1009878 | (05) | VT |