B Michael Southam O D PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

60235215 Issued in WA

Legal business name

B MICHAEL SOUTHAM O D PC

Doing business as

B. Michael Southam, O.D., PC/ Family Vision Care of Central Washington

Practice address

123 Hospital Way
Brewster, WA 98812-0578

Phone

(509) 689-2342

NPI assigned

Sep 21, 2011

Last updated

Aug 6, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Brant Michael Southam, O.D.

Title

Optometrist/Owner

Phone

(509) 689-2342

Specialties & licenses 1

Addresses

Other names 1

• B. Michael Southam, O.D., PC/ Family Vision Care of Central Washington Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1316563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344211200000",
    "number": "1235412784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 HOSPITAL WAY",
            "city": "BREWSTER",
            "state": "WA",
            "postal_code": "988120578",
            "telephone_number": "509-689-2342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 HOSPITAL WAY",
            "city": "BREWSTER",
            "state": "WA",
            "postal_code": "988120578",
            "telephone_number": "509-689-2342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "B MICHAEL SOUTHAM O D PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-21",
        "last_updated": "2012-08-06",
        "status": "A",
        "authorized_official_last_name": "SOUTHAM",
        "authorized_official_first_name": "BRANT",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OPTOMETRIST/OWNER",
        "authorized_official_telephone_number": "509-689-2342",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "60235215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "B. Michael Southam, O.D., PC/ Family Vision Care of Central Washington",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.