Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 4901002886 | MI |
NPI | 1013046259 |
---|---|
Provider Name | Dr. James Charles Reeves |
First Address | Fenton, MI 48430-2733 |
Second Address | Fenton, MI 48430-2733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U68154 | (02) | MI |