Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | S.5057 | OH |
NPI | 1144514514 |
---|---|
Provider Name | Mr. Michael James Petrie |
First Address | Akron, OH 44319-3027 |
Second Address | Akron, OH 44319-3027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2011 |
Last Update Date | 03/12/2011 |