NPI | 1962470864 |
---|---|
Former Name | REBECCA KAE MIKOLAJCZYK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: AK 130799) |
Additional Taxonomies | 152W00000X Optometrist (Licence: WA 3061) |
Enumeration Date | 2006-03-08 |
Last Update Date | 2018-10-17 |