Individual
MANA BOUSHEHRI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
2013022117
MO
152W00000X
Optometrist
Primary
3135
TN
152W00000X
Optometrist
883
MS
Other
Enumeration date
07/01/2013
Last updated
09/13/2018
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