Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2713 | AR |
N | 152W00000X | Optometrist | 2837 | TN |
NPI | 1003066382 |
---|---|
Provider Name | Anna Jane Schlesselman |
First Address | Little Rock, AR 72205-7101 |
Second Address | Little Rock, AR 72205-7101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2008 |
Last Update Date | 23/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1509308 | (05) | TN |
2837 | OD (01) | TN |
MS1814498 | DEA (01) | TN |