| NPI | 1346215134 |
|---|---|
| Former Name | SUZANNE R DETERVILLE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: NY TUV007085-1) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2007-07-09 |