| NPI | 1003092388 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE G FORECKI Optometrist/President 239-229-6423 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: IL 046-007557) |
| Enumeration Date | 2008-01-16 |
| Last Update Date | 2015-01-01 |