Organization
B MICHAEL SOUTHAM O D PC
Active
Other names
B. Michael Southam, O.D., PC/Family Vision Care of Central Washington
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRANT MICHAEL SOUTHAM O.D. (OPTOMETRIST/OWNER)
(509) 633-0340
Entity
Organization
Contact information
Practice address
407 BURDIN BLVD, GRAND COULEE, WA 99133-0054
(509) 633-0340
(509) 633-0161
Mailing address
PO BOX 54, GRAND COULEE, WA 99133-0054
(509) 633-0340
(509) 633-0161
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
60235215
WA
Other
Enumeration date
10/18/2011
Last updated
08/06/2012
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