| NPI | 1063415891 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES MENSCHIK Administrator 870-424-4900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: AR AR4264) |
| Additional Taxonomies | 261QS0132X Clinic/Center, Ophthalmologic Surgery |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2021-08-19 |