Individual
MIRA B BISEMBINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
002789
CT
152W00000X
Optometrist
Primary
1819
AZ
152W00000X
Optometrist
3327ATI
OR
Other
Enumeration date
12/10/2009
Last updated
01/31/2014
Update your record
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