| NPI | 1164699054 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROGER L. WILSON President 904-280-2021 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152WC0802X Optometrist Corneal and Contact Management (Licence: FL OP2569) |
| Enumeration Date | 2008-05-11 |
| Last Update Date | 2008-05-11 |