| NPI | 1154569069 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAKEIA J LOCKE CEO 202-320-7373 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT002490) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: GA OPT002490) |
| 152WS0006X Optometrist, Sports Vision (Licence: GA OPT002490) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: GA OPT002490) | |
| Enumeration Date | 2009-01-30 |
| Last Update Date | 2009-01-30 |