| NPI | 1205429008 |
|---|---|
| Former Name | REBECCA MATTESON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR ATI4628) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2021-02-12 |
| Last Update Date | 2022-06-15 |