NPI | 1023637360 |
---|---|
Former Name | AMY LEIGHANN BADE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: TX 10005) |
Additional Taxonomies | 152W00000X Optometrist (Licence: OK 3054) |
Enumeration Date | 2020-04-15 |
Last Update Date | 2024-10-30 |