| NPI | 1780612499 |
|---|---|
| Former Name | AMANDA LEANNE MOORE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ID ODP-100499) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AR 2566) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2020-09-09 |