Individual
MICHAEL T CHISM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OPTOMETRY STUDENT
Contact information
Practice address
6344 S 900 E, MURRAY, UT 84121-2439
(801) 892-8222
Mailing address
5924 S 1475 W, TAYLORSVILLE, UT 84123-5380
(909) 631-7188
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
CA
Other
Enumeration date
09/24/2011
Last updated
01/22/2015
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