| NPI | 1033111877 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE K EDWARDS Billing Manager 814-944-4011 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG000688) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002016) |
| 152W00000X Optometrist (Licence: PA OE004298) | |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2007-11-28 |