| NPI | 1134448806 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY WILLARD Practice Administrator 864-583-3125 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 1092) |
| Enumeration Date | 2010-05-20 |
| Last Update Date | 2013-04-11 |