Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 641 | ND |
NPI | 1003992694 |
---|---|
Provider Name | Barbra Brigitte Brookshire |
First Address | Fargo, ND 58103-5968 |
Second Address | Fargo, ND 58103-3357 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 08/07/2007 |