Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPT002144 | GA |
NPI | 1013012012 |
---|---|
Provider Name | Wayne Paul Gasser |
First Address | Vienna, VA 22182-3990 |
Second Address | Columbus, GA 31909 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 15/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
916387352A | (05) | GA |
V04537 | (02) |