NPI | 1891949830 |
---|---|
Former Name | HEIDI MARIE WILGENBURG |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: CA 13437) |
Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: CA 13437) |
152W00000X Optometrist (Licence: CO 2754) | |
Enumeration Date | 2008-11-04 |
Last Update Date | 2011-09-28 |