Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1063987618 |
---|---|
Provider Name | Stephen Williams |
First Address | Dallas, TX 75202-4522 |
Second Address | Dallas, TX 75202-4522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2018 |
Last Update Date | 10/10/2018 |