Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 13851 | CA |
NPI | 1013243807 |
---|---|
Provider Name | Laura E Schrupp |
First Address | Orinda, CA 94563-1930 |
Second Address | Orinda, CA 94563-1930 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2009 |
Last Update Date | 20/05/2015 |