Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO5929 | FL |
NPI | 1013494459 |
---|---|
Provider Name | Sarah Dawn Kern |
First Address | St Petersburg, FL 33714-3717 |
Second Address | Ruskin, FL 33573-6820 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2018 |
Last Update Date | 27/07/2018 |