NPI | 1962693317 |
---|---|
Former Name | ERICA LYNN OWEN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: WV 1052-OD) |
Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5734) |
Enumeration Date | 2007-08-09 |
Last Update Date | 2014-06-03 |