NPI | 1033301239 |
---|---|
Entity Type | Organization |
Authorized Contact | SHAUNE WALLACE President 435-674-3502 |
Organization Subpart ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: UT 6300367-9934) |
Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: UT 6300367-9934) |
152WP0200X Optometrist, Pediatrics (Licence: UT 6300367-9934) | |
152WV0400X Optometrist, Vision Therapy (Licence: UT 6300367-9934) | |
Enumeration Date | 2007-08-13 |
Last Update Date | 2011-06-15 |