Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 0618002631 | VA |
NPI | 1003314352 |
---|---|
Provider Name | Timoteo Flores-Bayer |
First Address | New Llano, LA 71461-9604 |
Second Address | Fort Polk, LA 71459-5102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2018 |
Last Update Date | 31/01/2018 |