Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | 09723 | WV |
NPI | 1124201843 |
---|---|
Provider Name | Sally Lue Reggel Oakes |
First Address | Huntington, WV 25701-5301 |
Second Address | Huntington, WV 25701-5301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2007 |
Last Update Date | 17/12/2007 |