Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3610 | FL |
NPI | 1013103563 |
---|---|
Provider Name | Thuy-Tran N Quach |
First Address | Orlando, FL 32835-3129 |
Second Address | Windermere, FL 34786-5933 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2007 |
Last Update Date | 20/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U0868 | (02) | FL |