| NPI | 1962597112 |
|---|---|
| Former Name | PENNY LYNN PETERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 2381) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MI 4901003736) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2019-05-28 |