Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 1513 | CO |
N | 152W00000X | Optometrist | 2001T | OR |
N | 152W00000X | Optometrist | 2068 | WA |
N | 152W00000X | Optometrist | 2211 | TN |
Y | 152W00000X | Optometrist | 8974T | CA |
NPI | 1003849712 |
---|---|
Provider Name | Dr. Pauline F Ilsen |
First Address | Los Angeles, CA 90073-1003 |
Second Address | Los Angeles, CA 90073-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2006 |
Last Update Date | 08/07/2007 |