Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 1277 | NC |
NPI | 1194998591 |
---|---|
Provider Name | Michael James Tatum |
First Address | Raleigh, NC 27615-6156 |
Second Address | Durham, NC 27705-4699 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2008 |
Last Update Date | 12/02/2013 |