| NPI | 1164519690 |
|---|---|
| Former Name | NIDA PETIKUN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN OD2788) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 4532T) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2010-04-13 |