Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1003478264 |
---|---|
Provider Name | Sherif Samaan |
First Address | Winter Park, FL 32789-2947 |
Second Address | Winter Park, FL 32789-7313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2019 |
Last Update Date | 08/07/2019 |