| NPI | 1154738433 |
|---|---|
| Former Name | JESSICA MARY BEAUREGARD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: RI ODTA00558) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 5030) |
| 152W00000X Optometrist (Licence: CA 33532) | |
| Enumeration Date | 2014-07-17 |
| Last Update Date | 2022-09-21 |