| NPI | 1679356786 | 
|---|---|
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC6355) | 
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT003527) | 
| Enumeration Date | 2023-08-14 | 
| Last Update Date | 2024-08-08 |