| NPI | 1104362680 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREEN GODDARD WALDRON President 757-253-7901 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618001279) |
| Enumeration Date | 2017-01-09 |
| Last Update Date | 2017-01-09 |