Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | LO 720 | CT |
NPI | 1023233285 |
---|---|
Provider Name | William B Davies |
First Address | Darien, CT 06820-3609 |
Second Address | Darien, CT 06820-3609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2007 |
Last Update Date | 03/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1215103320 | SUPPLIER NPI (01) | CT |