Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2243 | CO |
NPI | 1013086479 |
---|---|
Provider Name | Ashley Rae Ford Rottman |
First Address | Grand Junction, CO 81501-8133 |
Second Address | Grand Junction, CO 81501-8133 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 11/06/2012 |