Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1277 | VA |
NPI | 1053515536 |
---|---|
Provider Name | William Dale Slovak |
First Address | Fredericksburg, VA 22407-1122 |
Second Address | Fredericksburg, VA 22407-1122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2007 |
Last Update Date | 22/10/2008 |