Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 4901005241 | MI |
NPI | 1013576115 |
---|---|
Provider Name | Luke Lirones |
First Address | Big Rapids, MI 49307-2256 |
Second Address | Big Rapids, MI 49307-2256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2019 |
Last Update Date | 12/06/2019 |