| NPI | 1689743874 |
|---|---|
| Former Name | TIFFANY DIANE SHORT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL S-890-TA-469) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL 3962-OC3698) |
| 152W00000X Optometrist (Licence: GA OPT001985) | |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2021-03-01 |