| NPI | 1114129368 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID W CHEATHAM O PT Ometrist 662-494-5984 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Licence: MS MS656) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2012-11-27 |