| NPI | 1740805076 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC5861) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL 5861) |
| 152W00000X Optometrist (Licence: FL PENDING) | |
| 152W00000X Optometrist (Licence: GA OPT003274) | |
| Enumeration Date | 2020-06-12 |
| Last Update Date | 2022-03-08 |