Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO 1531 | WA |
NPI | 1215132832 |
---|---|
Provider Name | Mike Smilie |
First Address | Kennewick, WA 99336-2919 |
Second Address | Kennewick, WA 99336-2919 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2007 |
Last Update Date | 21/10/2008 |