Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | L-030453 | AR |
NPI | 1063837847 |
---|---|
Provider Name | Rick Rakotz |
First Address | Winslow, AR 72959-2605 |
Second Address | Winslow, AR 72959-2605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2014 |
Last Update Date | 03/03/2014 |