NPI | 1023156924 |
---|---|
Entity Type | Organization |
Authorized Contact | PHILIP L. MATTSON President 256-882-1024 |
Organization Subpart ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: AL S-A71-TA-632) |
Additional Taxonomies | 152WV0400X Optometrist Vision Therapy (Licence: AL S-A71-TA-632) |
Enumeration Date | 2007-02-02 |
Last Update Date | 2020-08-22 |