| NPI | 1861704751 |
|---|---|
| Former Name | AMANDA RENAE MARKS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2276) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5961) |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2017-06-09 |