Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 13578T | CA |
NPI | 1013172477 |
---|---|
Provider Name | Dr. Harry Miguel Green |
First Address | Berkeley, CA 94720 |
Second Address | Berkeley, CA 94720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2008 |
Last Update Date | 13/07/2016 |