NPI | 1013166651 |
---|---|
Former Name | SARAH BROSTKO |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: CT 2925) |
Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046010480) |
152W00000X Optometrist (Licence: FL OPC4300) | |
Enumeration Date | 2008-09-18 |
Last Update Date | 2023-01-27 |