Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPC5371 | FL |
NPI | 1003334863 |
---|---|
Provider Name | Heather Gauger |
First Address | Rockledge, FL 32955-3082 |
Second Address | Davie, FL 33328-2018 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2017 |
Last Update Date | 18/09/2017 |