| NPI | 1033340724 |
|---|---|
| Former Name | ANDREA JAE WITTROCK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NE 1361) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IA 2506) |
| Enumeration Date | 2009-07-29 |
| Last Update Date | 2024-01-16 |