Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 4049 | FL |
NPI | 1134791718 |
---|---|
Provider Name | Minina Mckie |
First Address | Miramar, FL 33029-6306 |
Second Address | Plantation, FL 33322-5234 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2021 |
Last Update Date | 13/07/2021 |