| NPI | 1124549332 |
|---|---|
| Former Name | CARLY JEAN GRONDIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG003398) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT003301) |
| 152W00000X Optometrist (Licence: NJ 27OA00684900) | |
| 152W00000X Optometrist (Licence: NY 008634) | |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2021-10-15 |