Individual
BRANT MICHAEL SOUTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1727
AZ
152W00000X
Optometrist
Primary
779
NV
152W00000X
Optometrist
OD60235215
WA
Other
Enumeration date
11/24/2009
Last updated
08/30/2018
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