Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FC0800X | Contact Lens | LDO002616 | GA |
N | 156FC0801X | Contact Lens Fitter | LDO002616 | GA |
Y | 156FX1800X | Optician | LDO002616 | GA |
NPI | 1588135305 |
---|---|
Provider Name | Shana Leigh Bailey |
First Address | Griffin, GA 30224-9010 |
Second Address | Thomaston, GA 30286-2209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2018 |
Last Update Date | 06/12/2018 |