Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 4901003836 | MI |
NPI | 1003992652 |
---|---|
Provider Name | Deborah Ann Sheere-Gallatin |
First Address | Brighton, MI 48116-6703 |
Second Address | Flint, MI 48532-3425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 10/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3463703 | (05) | MI |
U64254 | (02) | MI |