Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1164577029 |
---|---|
Provider Name | Mr. Michael S Pillen |
First Address | Gillette, WY 82718-6468 |
Second Address | Gillette, WY 82718-6468 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 09/07/2007 |