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 |