| NPI | 1053857078 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRYSTLE J MILLER President/O PT Ometrist 708-770-6404 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046010696) |
| Enumeration Date | 2017-01-13 |
| Last Update Date | 2017-01-13 |