Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 5348 | NY |
NPI | 1104942903 |
---|---|
Provider Name | Richard Weiss |
First Address | Staten Island, NY 10314-7592 |
Second Address | Brooklyn, NY 11235-2805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 08/07/2007 |