| NPI | 1134246119 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE M PAYNE Office Manager 810-235-4607 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2022-11-03 |