| NPI | 1114324670 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED SPENCER GRAY Managing Optometrist 907-841-5851 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: UT 90763589934) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: UT 90763589934) |
| 152WP0200X Optometrist, Pediatrics (Licence: UT 90763589934) | |
| 152WS0006X Optometrist, Sports Vision (Licence: UT 90763589934) | |
| Enumeration Date | 2014-11-29 |
| Last Update Date | 2015-03-09 |