| NPI | 1457684045 |
|---|---|
| Former Name | ANGELINE WYNNE MOUTON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT 002582) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC4475) |
| Enumeration Date | 2009-09-14 |
| Last Update Date | 2013-09-30 |