| NPI | 1922395854 |
|---|---|
| Former Name | JESSICA ANN CARSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO 2012013574) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OK 2686) |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2013-11-01 |