Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1013100379 |
---|---|
Provider Name | Sarah Row |
First Address | Dubuque, IA 52001-5934 |
Second Address | Dubuque, IA 52001-5934 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2007 |
Last Update Date | 21/08/2007 |