| NPI | 1104094887 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL L FAGIN Owner 317-815-8302 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18002571) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: IN 18002571B) |
| Enumeration Date | 2008-02-14 |
| Last Update Date | 2008-02-14 |