| NPI | 1144527417 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH B MORFOOT Manager 224-678-9043 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046010058) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046009952) |
| Enumeration Date | 2011-02-22 |
| Last Update Date | 2021-08-18 |