| NPI | 1376799288 |
|---|---|
| Former Name | KRISTIE JO CHARLES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046-010316) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WI 3112-35) |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2014-12-22 |