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Individual
GENNY VO
Active
Individual
GENNY VO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1795-729AT
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04530747
—
MS
05
—
2402838
—
LA
Enumeration date
08/13/2015
Last updated
03/30/2016
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