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 |