| NPI | 1013085935 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALVARO J MORENO Owner 601-549-1553 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MS 610) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2020-09-08 |