| NPI | 1053492744 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK A GILLISPIE Owner 760-347-6636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2009-11-03 |