B Michael Southam O D Pc Valid NPI

Organization · Optometrist · Grand Coulee, WA

NPI

1922383207

Type

Organization (Type 2)

Primary specialty

Optometrist

Specialty group

Eye and Vision Services Providers

Taxonomy code

152W00000X

License number

60235215 (WA)

Enumerated

2011-10-18

Last updated

2012-08-06