| NPI | 1104230200 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 008146) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA OPT15207-TLG) |
| 152W00000X Optometrist (Licence: CT 3312) | |
| 152W00000X Optometrist (Licence: IA 121412) | |
| 152W00000X Optometrist (Licence: VA 0618003317) | |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2023-10-16 |