Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 189 | RI |
N | 156FX1800X | Optician | 4475 | MA |
NPI | 1043260060 |
---|---|
Provider Name | Michael J Horan |
First Address | Middletown, RI 02842-5234 |
Second Address | Middletown, RI 02842-5234 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
21-02007 | UNITED HEALTHCARE (01) | RI |
22393-9 | BCBSRI,HMATE,HMATE2000 (01) | RI |
2440 | NHP OF RHODE ISLAND (01) | RI |
2490001 | (05) | RI |
408112 | BLUE CHIP,MCHIP,HMOBLUE (01) | RI |