Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 112 | AK |
NPI | 1013055698 |
---|---|
Provider Name | Dr. Gary Michael Kjome |
First Address | Anchorage, AK 99515-2029 |
Second Address | Anchorage, AK 99515-2029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2007 |
Last Update Date | 31/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U29703 | (02) |