| NPI | 1669712964 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 6423) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2013004092) |
| 152W00000X Optometrist (Licence: KS 1945) | |
| Enumeration Date | 2013-02-22 |
| Last Update Date | 2017-01-25 |