Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1114184744 |
---|---|
Provider Name | Miss Helen Barr Wilson |
First Address | Trenton, MI 48183-2323 |
Second Address | Trenton, MI 48183-2323 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2008 |
Last Update Date | 21/05/2008 |