| NPI | 1063100311 |
|---|---|
| Former Name | JACKIE VEGA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 11109) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2023-04-25 |
| Last Update Date | 2024-06-26 |