Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2004004593 | MO |
NPI | 1003979816 |
---|---|
Provider Name | Dr. Michael J Hawk |
First Address | Kansas City, MO 64156-7913 |
Second Address | Independence, MO 64055-7012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 01/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
128132 | (02) | MO |