Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1093737652 |
---|---|
Provider Name | Deb Giaseman |
First Address | Lake Odessa, MI 48849-1212 |
Second Address | Lake Odessa, MI 48849-1212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
164718 | ABOC (01) | MI |