| NPI | 1659360394 |
|---|---|
| Former Name | STACY LYNN PAUL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA 03945) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WY 280T) |
| Enumeration Date | 2005-10-16 |
| Last Update Date | 2012-01-03 |