Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPT002903 | GA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 27OA00564300 | NJ |
NPI | 1265523823 |
---|---|
Provider Name | Laura Jean Shipman |
First Address | Rockmart, GA 30153-2019 |
Second Address | Rockmart, GA 30153-2019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 15/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1019641200001 | (05) | PA |
U17849 | (02) | PA |