B. Michael Southam, Od, PC

NPI #1235550146 in Reno, Nevada

Provider Information

NPI Number: 1235550146
Entity Type: Organization
Organization Name: B. Michael Southam, Od, PC
Primary Specialty: Optometrist
Enumeration Date: Dec 18, 2013
Last Updated: Dec 18, 2013

Practice Location

Address: 3201 LAKESIDE DR
City: Reno
State: Nevada
ZIP Code: 89509-4830
Phone: (775) 825-0559

Authorized Official

Name: DR. BRANT MICHAEL SOUTHAM, OD
Title: OWNER/PRESIDENT
Phone: (775) 825-0559

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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