| NPI | 1760474647 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG002151) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: PA OEG002151) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2013-01-29 |