NPI | 1023246873 |
---|---|
Former Name | JILL ANITA SANDBAKKEN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: SD T681) |
Additional Taxonomies | 152W00000X Optometrist (Licence: IA 002458) |
Enumeration Date | 2009-06-30 |
Last Update Date | 2023-09-26 |