| NPI | 1073010146 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELA D PHILLABAUM Manager Of Billing And Insurance 765-453-3777 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology |
| Additional Taxonomies | 152W00000X Optometrist |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2020-01-28 |