| NPI | 1871686055 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 5699) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KS KS1547) |
| 332H00000X Eyewear Supplier | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2023-11-30 |