Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1101001654 | VA |
NPI | 1154482420 |
---|---|
Provider Name | Sandra H Trent |
First Address | Roanoke, VA 24018-5703 |
Second Address | Roanoke, VA 24018-5703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 08/07/2007 |