Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | C003703-1 | NY |
NPI | 1184778516 |
---|---|
Provider Name | Victor Hugo Olivos |
First Address | Jackson Heights, NY 11372-6538 |
Second Address | Jackson Heights, NY 11372-6538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 04/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00335882 | (05) | NY |