Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | TO2772 | MO |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | TO2772 | MO |
N | 152WP0200X | Pediatric Optomitrist | TO2772 | MO |
N | 152WX0102X | Occupational Vision | TO2772 | MO |
NPI | 1366436370 |
---|---|
Provider Name | Michael Shurley |
First Address | Neosho, MO 64850-1441 |
Second Address | Neosho, MO 64850-1441 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2005 |
Last Update Date | 29/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T42599 | (02) | MO |