Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0800X | Contact Lens | 145 | SC |
Y | 156FX1800X | Optician | 514 | SC |
NPI | 1386920031 |
---|---|
Provider Name | Theodore Avery Brown |
First Address | Florence, SC 29502 |
Second Address | Florence, SC 29501-4442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2011 |
Last Update Date | 26/10/2011 |