| NPI | 1033637046 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS ANDERSON Optometrist 307-760-4866 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO 2747) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CO 2747) |
| Enumeration Date | 2017-08-30 |
| Last Update Date | 2017-08-30 |