| NPI | 1114101136 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK L HOSTETLER Member 480-807-0288 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 1307) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AZ 349) |
| Enumeration Date | 2007-12-27 |
| Last Update Date | 2012-03-07 |