| NPI | 1952454035 |
|---|---|
| Former Name | BARBARA MARIE PORTILLO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046010966) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 7894T) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2019-01-02 |