Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 1524 | SC |
Y | 152W00000X | Optometrist | 1828DT | KY |
NPI | 1003041211 |
---|---|
Provider Name | Breyne Louise Middleton |
First Address | Columbia, SC 29209-1638 |
Second Address | Lexington, KY 40511-1052 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2009 |
Last Update Date | 17/12/2019 |