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General NPI Number Information
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NPI Number | 1205864402
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Entity Type | Individual
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Provider Name | MICHAEL E RAIM O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 01/05/2017
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Provider Practice Location Address
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Address Line | 501 HARBOR BLVD SUITE D
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City | DESTIN
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State | FL
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Zip | 32541-2348
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Country | US
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Telephone | 850-837-9161
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Fax | 850-837-9162
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Provider Business Mailing Address
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Address Line | 501 HARBOR BLVD SUITE D
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City | DESTIN
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State | FL
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Zip | 32541-2348
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Country | US
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Telephone | 850-837-9161
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Fax | 850-837-9162
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | OPC0001111
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 152WX0102X
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Taxonomy Name | Occupational Vision Optometrist
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License Number | OPC0001111
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License Number State | FL
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