NPI | 1043747595 |
---|---|
Former Name | STEPHANIE MICHELLE STANLEY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: AR 2763) |
Additional Taxonomies | 152W00000X Optometrist (Licence: OK 2955) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2017-05-15 |
Last Update Date | 2022-07-21 |