NPI | 1992169247 |
---|---|
Former Name | KAYLA AVIRETT |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: TX 9166TG) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2016-04-12 |
Last Update Date | 2021-06-02 |