| NPI | 1346766326 |
|---|---|
| Former Name | JUSTINE DURHAM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 5238) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: MA 5238) |
| Enumeration Date | 2017-08-21 |
| Last Update Date | 2018-08-06 |