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Contact Information

B MICHAEL SOUTHAM O D PC
407 BURDIN BLVD
GRAND COULEE, WA99133-0054
 Phone: 509-633-0340
 Fax: 509-633-0161
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for B MICHAEL SOUTHAM O D PC · (Female)

NPI Number 1922383207
Status Active
Credentials
Entity Individual
Enumeration date 10/18/2011
Last updated 08/06/2012 - About 14 years ago
Sole proprietor 1 Not specified
Identifiers
  • WA License # 60235215
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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