| NPI | 1639728975 |
|---|---|
| Former Name | JESSICA DANIELLE GRIMES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT003191) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA 3191) |
| Enumeration Date | 2019-09-09 |
| Last Update Date | 2023-07-21 |