Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 002350 | AZ |
NPI | 1013577576 |
---|---|
Provider Name | Kalynn Egea |
First Address | Peoria, AZ 85382-8313 |
Second Address | Peoria, AZ 85382-2114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2019 |
Last Update Date | 17/06/2019 |