| NPI | 1720217854 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618002020) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OK 2627) |
| 152W00000X Optometrist (Licence: MO 201001750) | |
| 152W00000X Optometrist (Licence: CT 002811) | |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2020-03-03 |