| NPI | 1053724203 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE CANDACE AHLMARK-GORDON Owner 229-344-6117 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT002136) |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2014-06-05 |