| NPI | 1023558996 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY DAWN ROGERS Owner 843-761-6485 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 1081) |
| Additional Taxonomies | 156FX1800X Technician/Technologist Optician (Licence: SC 717) |
| Enumeration Date | 2017-02-27 |
| Last Update Date | 2023-01-31 |