| NPI | 1073782199 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON DODDS Owner 731-627-1100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 2268) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: TN 2268) |
| Enumeration Date | 2008-02-22 |
| Last Update Date | 2013-12-03 |