| NPI | 1447414040 |
|---|---|
| Former Name | ANGELA MARIE VANDYKE |
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO 2015012017) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT002473) |
| Enumeration Date | 2008-07-12 |
| Last Update Date | 2016-06-16 |