NPI | 1073367132 |
---|---|
Former Name | JASMINE COLANGELO |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: WA 61673832) |
Additional Taxonomies | 152W00000X Optometrist (Licence: CO 0004063) |
152W00000X Optometrist (Licence: FL 6623) | |
Enumeration Date | 2024-04-15 |
Last Update Date | 2025-07-17 |