NPI | 1184900078 |
---|---|
Former Name | DANA RAE WEBSTER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2307) |
Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: MD TA2307) |
Enumeration Date | 2011-10-24 |
Last Update Date | 2014-01-28 |