Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 5893 | OH |
NPI | 1013147446 |
---|---|
Provider Name | Dr. Kristin S Middlesworth |
First Address | Grove City, OH 43123-9049 |
Second Address | Grove City, OH 43123-9049 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2009 |
Last Update Date | 10/05/2012 |