| NPI | 1831627900 |
|---|---|
| Former Name | KARLOTTA ALLYCE BUSHNELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: LA 1877-812AT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618002567) |
| Enumeration Date | 2017-06-01 |
| Last Update Date | 2021-12-07 |