Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 046-007839 | IL |
NPI | 1003093857 |
---|---|
Provider Name | Victoria Alfafara |
First Address | Broadview, IL 60155-4874 |
Second Address | Broadview, IL 60155-4874 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2008 |
Last Update Date | 03/04/2017 |