Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2017028246 | MO |
N | 152W00000X | Optometrist | 2721 | AR |
NPI | 1003298928 |
---|---|
Provider Name | Elena Lopez Hill |
First Address | Kennett, MO 63857-2522 |
Second Address | Kennett, MO 63857-2522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2015 |
Last Update Date | 04/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
210168722 | (05) | AR |