Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist | C001110 | AZ |
NPI | 1477962660 |
---|---|
Provider Name | Trent T Hadlock |
First Address | Gilbert, AZ 85296-4799 |
Second Address | Gilbert, AZ 85296-4799 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2014 |
Last Update Date | 04/12/2014 |