Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1101002515 | VA |
NPI | 1134501091 |
---|---|
Provider Name | Stephen Powell |
First Address | Charlottesville, VA 22902-5214 |
Second Address | Charlottesville, VA 22902-5214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2015 |
Last Update Date | 26/06/2015 |