Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 0601001043 | VA |
NPI | 1003952763 |
---|---|
Provider Name | Robert M. Fornili |
First Address | Mechanicsville, VA 23116-6525 |
Second Address | Mechanicsville, VA 23111-3550 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 08/07/2007 |