Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 005182-1 | NY |
NPI | 1184127896 |
---|---|
Provider Name | Wendy Oddo |
First Address | Amherst, NY 14226-1727 |
Second Address | Amherst, NY 14226-1727 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2018 |
Last Update Date | 09/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1376924944 | (05) | NY |