Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1215994074 |
---|---|
Provider Name | Michael Andrew Bradshaw |
First Address | Lawrenceburg, IN 47025-1171 |
Second Address | Lawrenceburg, IN 47025-1171 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 14/01/2008 |