| NPI | 1104430537 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAFAEL GAMBA Owner 770-361-9481 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 152WP0200X Optometrist Pediatrics |
| Enumeration Date | 2020-09-02 |
| Last Update Date | 2020-11-19 |