| NPI | 1083644900 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA ANN OVERLY Vice President 920-499-2147 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WI 1546035) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WI 2511035) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2010-11-11 |