Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 3899T1212 | OH |
NPI | 1285800888 |
---|---|
Provider Name | Michael John Tangeman |
First Address | Sidney, OH 45365-9080 |
Second Address | Sidney, OH 45365-9080 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2008 |
Last Update Date | 02/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U25553 | (02) | OH |