| NPI | 1093077984 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT H PETERMANN Owner 229-391-4126 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology |
| Additional Taxonomies | 152W00000X Optometrist |
| 152WC0802X Optometrist, Corneal and Contact Management | |
| 152WP0200X Optometrist, Pediatrics | |
| 152WS0006X Optometrist, Sports Vision | |
| 332H00000X Eyewear Supplier (Equipment, not the service) | |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2012-06-15 |