Organization
B. MICHAEL SOUTHAM, OD, PC
Active
Parent organization
B. MICHAEL SOUTHAM OD, PC
Other names
Black Rock Vision Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
B. MICHAEL SOUTHAM OD, PC
Authorized official
KATHRYN SOUTHAM (MANAGER)
(775) 825-0559
Entity
Organization
Contact information
Practice address
625 SHEEHAN ST APT E, WINNEMUCCA, NV 89445-3675
(775) 625-4733
(775) 625-4735
Mailing address
3201 LAKESIDE DR, RENO, NV 89509-4830
(775) 825-0559
(775) 829-7918
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
05/08/2019
Last updated
05/08/2019
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