Kelly Rae Pettigrew, OPTICIAN LICENSE FL

NPI #1164917373 in Dulce, New Mexico

Provider Information

NPI Number: 1164917373
Entity Type: Individual
Name: Kelly Rae Pettigrew, OPTICIAN LICENSE FL
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Optometrist
Credential: OPTICIAN LICENSE FL
Enumeration Date: Jun 29, 2018
Last Updated: Jun 29, 2018

Practice Location

Address: 505 NORTH MUNDO
City: Dulce
State: New Mexico
ZIP Code: 87528
Phone: (575) 759-3291

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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