NPI | 1356728778 |
---|---|
Former Name | ASHLEY ANNE THOLEN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: IA 098906) |
Additional Taxonomies | 152W00000X Optometrist (Licence: MI 4901005080) |
Enumeration Date | 2015-05-05 |
Last Update Date | 2021-06-03 |