Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPC3701 | FL |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OPC3701 | FL |
NPI | 1083824361 |
---|---|
Provider Name | Michelle M Hebert |
First Address | Indialantic, FL 32903-2940 |
Second Address | Daytona Beach, FL 32119-1604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 30/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36065 | BCBS FL (01) | FL |