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General NPI Number Information
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NPI Number | 1871354555
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Entity Type | Individual
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Provider Name | MIRANDA THOMPSON ABOC, NCLEC, FL LDO
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Gender | Female
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Dates
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Enumeration Date | 01/19/2024
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 601 N LINCOLN RD
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City | ESCANABA
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State | MI
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Zip | 49829-1426
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Country | US
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Telephone | 906-786-2466
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Fax | 906-786-9174
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Provider Business Mailing Address
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Address Line | 1446 SHORE DR
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City | MARINETTE
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State | WI
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Zip | 54143-3508
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Country | US
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Telephone | 904-548-7841
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Fax |
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | DO7031
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License Number State | FL
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