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

407 Burdin Blvd
Grand Coulee, WA 99133-0054

Phone

(509) 633-0340

Fax

(509) 633-0161

NPI assigned

Oct 18, 2011

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) 633-0340

Specialties & licenses 1

Addresses

Other names 1

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

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Duane L Rana, OD

  • Optometrist
  • Grand Coulee, WA
  • NPI 1851328801
  NPD (past)
• Galen Neal Schmidt, OD

  • Optometrist
  • Grand Coulee, WA
  • NPI 1629171616
  NPD (past)

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

{
    "created_epoch": "1318896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344211200000",
    "number": "1922383207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 54",
            "city": "GRAND COULEE",
            "state": "WA",
            "postal_code": "991330054",
            "telephone_number": "509-633-0340",
            "fax_number": "509-633-0161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 BURDIN BLVD",
            "city": "GRAND COULEE",
            "state": "WA",
            "postal_code": "991330054",
            "telephone_number": "509-633-0340",
            "fax_number": "509-633-0161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "B MICHAEL SOUTHAM O D PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-18",
        "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": "509-633-0340",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  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"
        }
    ]
}

• Chalice Jalene Arden, ARNP
• Virginia B Baccellia-Ziegler, MS
• David Martin Brown, CRNA
• Samantha B Brunner, PA-C
• Andrew Cecil Castrodale, MD
• Jacob Petersen Chaffee, MD

• Optometrist in Grand Coulee, WA
• Providers in Grand Coulee, WA by specialty
• Optometrist in Washington

• 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.