| NPI | 1801842562 |
|---|---|
| Former Name | MARIAN RUTH AYDELOTTE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IA 02044) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046-008889) |
| 152W00000X Optometrist (Licence: WI 2610-035) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2011-07-22 |