Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FX1100X | Ophthalmic | ||
Y | 156FX1800X | Optician |
NPI | 1417190638 |
---|---|
Provider Name | Sheena M Tillman |
First Address | Columbia, MD 21044-3341 |
Second Address | Columbia, MD 21044-3341 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2009 |
Last Update Date | 17/04/2009 |