| NPI | 1649345190 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 911DT) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Licence: KY 911DT) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2013-11-14 |