Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 482 | SC |
NPI | 1023269412 |
---|---|
Provider Name | Robert Mark Wilkins |
First Address | Spartanburg, SC 29303-3178 |
Second Address | Spartanburg, SC 29303-3178 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2008 |
Last Update Date | 04/10/2008 |