| NPI | 1760582308 |
|---|---|
| Former Name | CARRIE MARIE MCDANIEL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IA 002396) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046.009900) |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2019-09-23 |