Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 005804-1 | NY |
NPI | 1023205309 |
---|---|
Provider Name | Gregory Vincent Michaels |
First Address | Tonawanda, NY 14150-3944 |
Second Address | Tonawanda, NY 14150-3944 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2007 |
Last Update Date | 01/10/2007 |