Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 998 | AZ |
NPI | 1013134600 |
---|---|
Provider Name | Dr. Karen Stonebraker Simon |
First Address | Gilbert, AZ 85296-3054 |
Second Address | Gilbert, AZ 85296-3054 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 08/07/2014 |