Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | NY008056-1 | NY |
NPI | 1215443775 |
---|---|
Provider Name | Samantha Joanne Tobias |
First Address | Horseheads, NY 14845-2297 |
Second Address | Horseheads, NY 14845-2297 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2017 |
Last Update Date | 20/12/2017 |