| NPI | 1912160540 |
|---|---|
| Former Name | MELISSA PHYLLIS SAMUELSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ND 706) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MN 3131) |
| 152W00000X Optometrist (Licence: MT 1933) | |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2023-03-07 |