| NPI | 1497815856 |
|---|---|
| Former Name | CELESTE LORENE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901004061) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 4901004061) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2022-03-31 |