| NPI | 1114105731 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT W HAM O PT Ician/Owner 904-268-5949 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Licence: FL OE263) |
| Additional Taxonomies | 332H00000X Eyewear Supplier |
| Enumeration Date | 2008-02-06 |
| Last Update Date | 2019-10-16 |