Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 16687 | OH |
NPI | 1093233306 |
---|---|
Provider Name | Robin P Wiley |
First Address | Avon, OH 44011-2623 |
Second Address | Avon, OH 44011-2623 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2017 |
Last Update Date | 07/09/2017 |