| NPI | 1003002155 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREN DICKERMAN President 6173-354-5590 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 4211) |
| Additional Taxonomies | 152WP0200X Optometrist Pediatrics (Licence: MA 4211) |
| 152WS0006X Optometrist Sports Vision (Licence: MA 4211) | |
| 156FC0800X Technician/Technologist Contact Lens (Licence: MA 4211) | |
| 156FC0801X Technician/Technologist Contact Lens Fitter (Licence: MA 4211) | |
| 156FX1800X Technician/Technologist Optician (Licence: MA 6165) | |
| Enumeration Date | 2007-09-22 |
| Last Update Date | 2008-03-04 |