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General NPI Number Information
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NPI Number | 1952092801
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Entity Type | Individual
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Provider Name | ETTA MARIE THANE ABOC
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Gender | Female
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Dates
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Enumeration Date | 05/19/2023
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Last Update Date | 05/19/2023
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Provider Practice Location Address
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Address Line | 1121 E CARO RD
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City | CARO
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State | MI
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Zip | 48723-1216
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Country | US
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Telephone | 989-672-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 4657 HOSPITAL DR
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City | CASS CITY
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State | MI
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Zip | 48726-1010
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Country | US
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Telephone | 989-670-5003
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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 | 157033
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License Number State | MI
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