Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 008114 | CO |
NPI | 1083805766 |
---|---|
Provider Name | Theresa Ann Burns |
First Address | Montrose, CO 81401-5719 |
Second Address | Montrose, CO 81401-5719 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2007 |
Last Update Date | 13/10/2008 |