Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 009495 | NY |
NPI | 1013671593 |
---|---|
Provider Name | Thomas Cannone |
First Address | Woonsocket, RI 02895 |
Second Address | Ridgewood, NY 11385-2644 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2021 |
Last Update Date | 29/10/2021 |