| NPI | 1073719910 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY WAYNE LONG Owner O PT Omotrist 573-785-8476 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO T02229) |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2015-01-08 |