| NPI | 1073882429 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER M GUDAS Optometrist 574-946-3944 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18003318B) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: IN 18003318B) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: IN 18003318B) | |
| 152WP0200X Optometrist, Pediatrics (Licence: IN 18003318B) | |
| Enumeration Date | 2011-12-14 |
| Last Update Date | 2011-12-25 |