Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist | 09-318-21 | MO |
NPI | 1891294948 |
---|---|
Provider Name | Corinne Laura Lige |
First Address | Saint Louis, MO 63131-2393 |
Second Address | Saint Louis, MO 63131-2393 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2018 |
Last Update Date | 05/02/2018 |