Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DPO000000791 | TN |
NPI | 1164853354 |
---|---|
Provider Name | Mr. Christopher Moore Milam |
First Address | Nashville, TN 37215-2707 |
Second Address | Nashville, TN 37215-2707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2013 |
Last Update Date | 18/12/2013 |