| NPI | 1275898173 |
|---|---|
| Former Name | STEPHANIE LYNN IVERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO 2013023063) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 3051) |
| 152W00000X Optometrist (Licence: MS 862) | |
| Enumeration Date | 2012-07-07 |
| Last Update Date | 2014-11-19 |