| NPI | 1629050604 |
|---|---|
| Former Name | MINDY JANE GORDON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IA 2321) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NE 1238) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2019-04-11 |