| NPI | 1386216885 |
|---|---|
| Former Name | AMANDA MARIE HANSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ND 799) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD 2935) |
| 152W00000X Optometrist (Licence: WI 3852-35) | |
| 152W00000X Optometrist (Licence: MN 3730) | |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2023-07-18 |