Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO 00001859 | WA |
NPI | 1023261435 |
---|---|
Provider Name | Mr. Michael Ray Davis |
First Address | Yakima, WA 98908-4318 |
Second Address | Yakima, WA 98908-4318 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2008 |
Last Update Date | 24/09/2010 |