| NPI | 1962401612 |
|---|---|
| Former Name | MICHAEL RAYMOND KEVERLINE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101230614) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: VA 7010360) |
| Enumeration Date | 2005-07-15 |
| Last Update Date | 2008-05-08 |