NPI | 1174534051 |
---|---|
Former Name | AMANDA RACHELLE WINDES |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: KS 1724) |
Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2004034233) |
Enumeration Date | 2006-08-10 |
Last Update Date | 2022-03-16 |