Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 111351 | KY |
NPI | 1093396186 |
---|---|
Provider Name | Tiffany Maria Beasley |
First Address | Louisville, KY 40216-2565 |
Second Address | Louisville, KY 40216-2565 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2021 |
Last Update Date | 20/04/2021 |