| NPI | 1043453509 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY ELMORE President 317-908-8548 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18003454) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: IN 18003454) |
| 152WP0200X Optometrist, Pediatrics (Licence: IN 18003454) | |
| 152WS0006X Optometrist, Sports Vision (Licence: IN 18003454) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: IN 18003454) | |
| 152WX0102X Optometrist, Occupational Vision (Licence: IN 18003454) | |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2009-04-14 |