| NPI | 1063165108 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL 6362) | 
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 5529) | 
| Enumeration Date | 2022-01-29 | 
| Last Update Date | 2025-02-26 |