| NPI | 1568999332 |
|---|---|
| Other Name | JACKIE COSGROVE MALLEIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901005682) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA OD60861196) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2024-01-15 |