Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0800X | Contact Lens | 652 | NV |
N | 156FC0801X | Contact Lens Fitter | 652 | NV |
Y | 156FX1800X | Optician | 652 | NV |
NPI | 1407418932 |
---|---|
Provider Name | Samuel Madrid |
First Address | Las Vegas, NV 89146-1455 |
Second Address | Las Vegas, NV 89146-1455 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2019 |
Last Update Date | 04/07/2019 |