NPI | 1225261266 |
---|---|
Former Name | MARY KORMANAK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: MA 4772) |
Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002201) |
Enumeration Date | 2009-08-25 |
Last Update Date | 2019-07-09 |