Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPT002842 | GA |
N | 152W00000X | Optometrist | TUV008095 | NY |
NPI | 1013331750 |
---|---|
Provider Name | Reema Gosalia |
First Address | Dallas, TX 75320-7173 |
Second Address | Atlanta, GA 30305-2193 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2014 |
Last Update Date | 30/04/2018 |