Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DOPD259 | AK |
NPI | 1083105001 |
---|---|
Provider Name | Sandi Acquistapace |
First Address | North Pole, AK 99705-0897 |
Second Address | North Pole, AK 99705-7754 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2018 |
Last Update Date | 24/05/2018 |