| NPI | 1801960679 |
|---|---|
| Former Name | MINTA SUSAN IVENS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: AZ ACVREP 2540) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2007-07-08 |