Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 030.0121007 | VT |
NPI | 1003264631 |
---|---|
Provider Name | Kayla Brenden |
First Address | Middlebury, VT 05753-1335 |
Second Address | Middlebury, VT 05753-1335 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2016 |
Last Update Date | 24/05/2016 |