| NPI | 1457765604 |
|---|---|
| Former Name | STACY JO KOSTER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR 3548ATI) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: OR 3548ATI) |
| 152WV0400X Optometrist, Vision Therapy (Licence: OR 3548ATI) | |
| Enumeration Date | 2014-06-16 |
| Last Update Date | 2019-12-06 |