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Individual
MICHAEL JAMES THAANUM
Active
Individual
MICHAEL JAMES THAANUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
6571TPA
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1306035118
RETIRED RAILROAD MEDICARE
CA
05
—
1306035118
—
CA
01
—
6191070001
DME MACS PTAN
CA
Enumeration date
01/16/2007
Last updated
10/14/2009
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