| NPI | 1740630730 |
|---|---|
| Former Name | CARRIE KAY CHRISTOPHERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG003202) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2016-06-29 |