| NPI | 1033203989 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENELL GUST Billing Specialist 419-720-3937 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 152WL0500X Optometrist Low Vision Rehabilitation |
| 152WX0102X Optometrist Occupational Vision | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2020-08-22 |