Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 2021023744 | MO |
NPI | 1205406766 |
---|---|
Provider Name | Miss Jessica L. Weis |
First Address | Hazelwood, MO 63042-2735 |
Second Address | Hazelwood, MO 63042-3521 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2021 |
Last Update Date | 28/06/2021 |