=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063273399
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES PULS LDO ABO-AC/ NCLE-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2024
-----------------------------------------------------
Last Update Date | 01/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 S HIGHWAY 160
-----------------------------------------------------
City | PAHRUMP
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-537-1417
-----------------------------------------------------
Fax | 775-537-1419
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 S HIGHWAY 160
-----------------------------------------------------
City | PAHRUMP
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89048
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-537-1417
-----------------------------------------------------
Fax | 775-537-1419
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number | 799
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------