NPI | 1376899633 |
---|---|
Former Name | JESSICA RENEE GANDY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: TX 8014T) |
Additional Taxonomies | 152W00000X Optometrist (Licence: AR 2678) |
152W00000X Optometrist (Licence: OK 2730) | |
Enumeration Date | 2012-07-24 |
Last Update Date | 2023-07-03 |