Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0800X | Contact Lens | C006866-1 | NY |
N | 156FC0801X | Contact Lens Fitter | C006886-1 | NY |
Y | 156FX1800X | Optician | C006866-1 | NY |
NPI | 1457864134 |
---|---|
Provider Name | Michelle Bullock |
First Address | Canandaigua, NY 14424-1787 |
Second Address | Canandaigua, NY 14424-1787 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2017 |
Last Update Date | 17/03/2018 |