Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2304 | SC |
NPI | 1003578881 |
---|---|
Provider Name | Alyssa Jagdeo |
First Address | Brampton, ONTARIO L6P1X6 |
Second Address | North Charleston, SC 29406-4057 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2021 |
Last Update Date | 15/10/2021 |