Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 270A00675200 | NJ |
NPI | 1891219945 |
---|---|
Provider Name | Dr. David Klatz |
First Address | Ship Bottom, NJ 08008-4443 |
Second Address | Ship Bottom, NJ 08008-4443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2017 |
Last Update Date | 31/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
270A00675200 | NJ BOARD OF OPTOMETRY (01) | NJ |