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 |