| NPI | 1629628292 |
|---|---|
| Former Name | MARIELLE GRACE BLUMENTHALER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH OPT.006732) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 34402) |
| Enumeration Date | 2019-09-16 |
| Last Update Date | 2020-12-21 |