Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | C006500 | NY |
NPI | 1992211486 |
---|---|
Provider Name | Carolyn Sue Murdock |
First Address | Potsdam, NY 13676-3577 |
Second Address | Potsdam, NY 13676-3577 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2017 |
Last Update Date | 19/12/2017 |