| NPI | 1053365056 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA RENEE NICHOLS Practice Manager 941-794-2020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: FL ME0045451) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC3917) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2008-04-10 |