| NPI | 1053349613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RODERICK BLAIR BEAZER Owner 801-623-1390 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA 2085) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2020-10-28 |