Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0800X | Contact Lens | ||
N | 156FX1100X | Ophthalmic | ||
Y | 156FX1800X | Optician |
NPI | 1871116426 |
---|---|
Provider Name | Sara Ann Underwood |
First Address | Columbus, GA 31909-5316 |
Second Address | Phenix City, AL 36870 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2020 |
Last Update Date | 04/08/2020 |