Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | C-004639 | NY |
NPI | 1235307646 |
---|---|
Provider Name | Tim Fabozzi |
First Address | Denver, CO 80202-6115 |
Second Address | Denver, CO 80202-6115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2008 |
Last Update Date | 19/02/2008 |