Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 005967 | NY |
NPI | 1205038965 |
---|---|
Provider Name | Todd T Rodabaugh |
First Address | Horseheads, NY 14845-2443 |
Second Address | Horseheads, NY 14845-2443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02064217 | (05) | NY |