| NPI | 1619111762 |
|---|---|
| Former Name | KELSEY MARIE BLOCH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AR 2640) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN 2889) |
| Enumeration Date | 2009-04-20 |
| Last Update Date | 2014-01-10 |