NPI | 1164791919 |
---|---|
Former Name | LEZLIE PEARL ANDERSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3407) |
Additional Taxonomies | 152W00000X Optometrist (Licence: IA 002535) |
Enumeration Date | 2011-12-23 |
Last Update Date | 2024-01-29 |