Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 61891T | TX |
NPI | 1003921529 |
---|---|
Provider Name | Dr. Michael James Stewart |
First Address | Garland, TX 75040-8794 |
Second Address | Garland, TX 75040-8794 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 08/07/2007 |