Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 005159-1 | NY |
NPI | 1144320805 |
---|---|
Provider Name | Wayne J Kelly |
First Address | Manhasset, NY 11030-3026 |
Second Address | Manhasset, NY 11030-3026 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2006 |
Last Update Date | 12/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02604960 | (05) | NY |
1002050000 | UFT (01) | NY |
18046 | DAVIS VISION (01) | NY |
837 | VISION SCREENING (01) | NY |
NY5159 | EYEMED (01) | NY |