| NPI | 1023330370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER JUSTIN HOLCOMB O PT Ometrist 305-785-1886 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: WA OD60102641) |
| Additional Taxonomies | 305S00000X Point of Service (Licence: WA OD60102641) |
| 305R00000X Preferred Provider Organization (Licence: FL OPC4902) | |
| Enumeration Date | 2010-02-26 |
| Last Update Date | 2015-06-23 |