| NPI | 1093040511 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY REILE BRYSON TARR Optometrist/Member Manager 336-469-2691 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2176) |
| Enumeration Date | 2009-10-16 |
| Last Update Date | 2009-10-16 |