| NPI | 1023120409 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUCY DINGMAN Billing Representative 904-272-2020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology |
| Additional Taxonomies | 152W00000X Optometrist |
| 156FC0800X Technician/Technologist Contact Lens | |
| 174400000X Specialist | |
| 332H00000X Eyewear Supplier | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2024-06-27 |