B Michael Southam O D PC
NPI #1922383207 in Grand Coulee, Washington
Provider Information
- NPI Number
- 1922383207
- Entity Type
- Organization
- Organization Name
- B Michael Southam O D PC
- Primary Specialty
- Optometrist
- Enumeration Date
- Oct 18, 2011
- Last Updated
- Aug 6, 2012
Practice Location
- Address
- 407 BURDIN BLVD
- City
- Grand Coulee
- State
- Washington
- ZIP Code
- 99133-0054
- Phone
- (509) 633-0340
Authorized Official
- Name
- DR. BRANT MICHAEL SOUTHAM, O.D.
- Title
- OPTOMETRIST/OWNER
- Phone
- (509) 633-0340
Specialties & Taxonomy Codes
| Specialty |
|---|
| Optometrist |
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