Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1043610173 |
---|---|
Provider Name | Mrs. Laura Lamse |
First Address | Wyoming, MI 49509-3417 |
Second Address | Wyoming, MI 49509-3417 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2014 |
Last Update Date | 26/08/2014 |