| NPI | 1093229718 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY RYAN WIEDRICH Optometrist 806-336-7105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: CO OPT.0002664) |
| Enumeration Date | 2017-11-17 |
| Last Update Date | 2018-01-11 |