Individual
MRS. MICHELLE RENEE DURHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
2005035713
MO
152W00000X
Optometrist
2639
AR
152W00000X
Optometrist
764
HI
152W00000X
Optometrist
Primary
OD60798589
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2098744
—
WA
Enumeration date
02/25/2008
Last updated
11/13/2020
Update your record
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