Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPC00003235 | FL |
NPI | 1013063171 |
---|---|
Provider Name | Melissa Sue Green |
First Address | Cape Coral, FL 33904-4158 |
Second Address | Cape Coral, FL 33904-4158 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 10/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U76228 | (02) | FL |