Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1114013380 |
---|---|
Provider Name | Ms. Kay L Harris |
First Address | Burton, MI 48529-2212 |
Second Address | Burton, MI 48529-2212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2777406 | (05) | MI |
900B576420 | BCBSM (01) | MI |