NPI | 1598040354 |
---|---|
Former Name | KELLY LAINE HONSINGER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT002997) |
Additional Taxonomies | 152W00000X Optometrist (Licence: AL R-256-TA-B08) |
152W00000X Optometrist (Licence: MS 842) | |
152W00000X Optometrist (Licence: FL OPC004662) | |
Enumeration Date | 2011-10-12 |
Last Update Date | 2021-08-12 |