Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 4901004894 | MI |
NPI | 1013390921 |
---|---|
Provider Name | Dr. Allison Ezell |
First Address | Burton, MI 48509-1700 |
Second Address | Burton, MI 48509-1700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2015 |
Last Update Date | 09/07/2015 |