Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 007486-1 | NY |
NPI | 1194957787 |
---|---|
Provider Name | Mrs. Marcia Monica Michaels |
First Address | East Aurora, NY 14052-2129 |
Second Address | East Aurora, NY 14052-2129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2009 |
Last Update Date | 14/08/2009 |