Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist | ||
N | 156FX1800X | Optician |
NPI | 1841416062 |
---|---|
Provider Name | Mr. Michael R Barrett |
First Address | Eau Claire, WI 54701-7075 |
Second Address | Eau Claire, WI 54701-7075 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 25/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1841416062 | (05) | WI |
38430000 | (05) | WI |