Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | ||
N | 156FC0800X | Contact Lens | ||
N | 156FX1800X | Optician |
NPI | 1639309107 |
---|---|
Provider Name | Sandy Cruz |
First Address | Thornton, CO 80260-6893 |
Second Address | Thornton, CO 80260-6893 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2009 |
Last Update Date | 19/07/2009 |