Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XL0004X | Low Vision | 9052 | NC |
NPI | 1558787705 |
---|---|
Provider Name | Michelle Reed |
First Address | Garner, NC 27529-4395 |
Second Address | Garner, NC 27529-4395 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2014 |
Last Update Date | 12/03/2014 |