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 |