| NPI | 1336199413 |
|---|---|
| Former Name | REGINA LORRAINNE MCCOLLUM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA GA1647) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: GA GA1647) |
| 152WP0200X Optometrist Pediatrics (Licence: GA GA1647) | |
| 152WV0400X Optometrist Vision Therapy (Licence: GA GA1647) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2008-03-03 |