Individual
IAN MAISONVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3017 INDIAN CREST DR, PELHAM, AL 35124-4701
(205) 529-0557
Mailing address
3017 INDIAN CREST DR, PELHAM, AL 35124-4701
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3645
TN
Other
Enumeration date
09/10/2020
Last updated
10/02/2020
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