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Individual

ALISON DOMENICA KITZEROW

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
OD

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
AZ 2038
AZ
152W00000X
Optometrist
OPT002755
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2038
AZ MEDICAL LICENSE
AZ
01
OPT002755
GA OPTOMETRY LICENSE
GA
Enumeration date
07/02/2013
Last updated
02/19/2016
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