Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 03331 | FL |
NPI | 1174647747 |
---|---|
Provider Name | Suzy D. Lepak |
First Address | St Petersburg, FL 33703-2252 |
Second Address | St Petersburg, FL 33703-2252 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 08/07/2007 |