Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 007229-1 | NY |
NPI | 1013147966 |
---|---|
Provider Name | Susan M Mullen |
First Address | Glens Falls, NY 12801-2329 |
Second Address | Glens Falls, NY 12801-2329 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2009 |
Last Update Date | 16/04/2013 |