| NPI | 1063862126 |
|---|---|
| Former Name | KELLY BETH FREEBORN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO OPT.0003214) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IA 091132) |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2020-11-05 |