Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPT 001337 | GA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OPT 001337 | GA |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | OPT 001337 | GA |
N | 152WP0200X | Pediatric Optomitrist | OPT 001337 | GA |
N | 152WS0006X | Sports Vision | OPT 001337 | GA |
N | 152WV0400X | Optomitrist - Vision Therapist | OPT 001337 | GA |
N | 152WX0102X | Occupational Vision | OPT 001337 | GA |
NPI | 1205861846 |
---|---|
Provider Name | Kristin L Bender |
First Address | Johns Creek, GA 30022-8532 |
Second Address | Johns Creek, GA 30022-8532 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 29/09/2010 |