| NPI | 1154456077 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES WACHTER Doctor 636-200-4393 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL S480TA132) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: AL S480TA132) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2020-02-25 |