Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 4901005085 | MI |
NPI | 1013428648 |
---|---|
Provider Name | Dr. Ryan Chahine |
First Address | Madison Heights, MI 48071-2416 |
Second Address | Madison Heights, MI 48071-2416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2017 |
Last Update Date | 15/01/2018 |