Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 4901004495 | MI |
NPI | 1003063306 |
---|---|
Provider Name | Jamie Marie Shay |
First Address | Jackson, MI 49202-3196 |
Second Address | Lansing, MI 48912-3752 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2008 |
Last Update Date | 20/09/2018 |