| NPI | 1003112012 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE V. CRAIG Administrative Assistant 417-831-0555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: MO T03116) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO T03116) |
| Enumeration Date | 2011-02-09 |
| Last Update Date | 2011-09-16 |