| NPI | 1003864976 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONTGOMERY VICKERS Clinical Director 304-727-8321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WV 701 O.D.) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2008-01-28 |