| NPI | 1104287374 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN GORDON MCDANIEL President 262-751-2834 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: CO 2702) |
| Additional Taxonomies | 152W00000X Optometrist |
| Enumeration Date | 2016-03-15 |
| Last Update Date | 2024-01-22 |