| NPI | 1063680304 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | W DOUGLAS BACK Secretary/Member 859-278-8443 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: KY 21381) |
| Additional Taxonomies | 152W00000X Optometrist |
| Enumeration Date | 2008-02-20 |
| Last Update Date | 2008-09-08 |