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 |