| NPI | 1629127964 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG-000169) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: PA OEG-000169) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2012-01-10 |