Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 80-0353583 | MI |
NPI | 1104067859 |
---|---|
Provider Name | Mrs. Lasandrus Morris |
First Address | Detroit, MI 48204 |
Second Address | Detroit, MI 48224-2455 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2009 |
Last Update Date | 10/03/2009 |