Individual
GRACE LISETTE RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LDO
Contact information
Practice address
351 ALABAMA RD, ADEL, GA 31620-3818
(229) 896-9994
(229) 896-9996
Mailing address
351 ALABAMA RD, ADEL, GA 31620-3818
(229) 896-9994
(229) 896-9996
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
002857
GA
Other
Enumeration date
04/24/2024
Last updated
04/24/2024
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