| NPI | 1417122383 |
|---|---|
| Former Name | ALISSA DIANE JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 2866) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18003083A) |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2019-03-21 |