Individual
ALICIA DENEE DERRY
Active
Individual
ALICIA DENEE DERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
046.009254
IL
152WP0200X
Pediatric Optometrist
Primary
7336TG
TX
Other
Enumeration date
09/05/2006
Last updated
02/29/2012
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