Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | IL |
NPI | 1164533394 |
---|---|
Provider Name | Dr. Anita Elaine Pearson |
First Address | Willowbrook, IL 60527-2617 |
Second Address | Bridgeview, IL 60455-2401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |