| NPI | 1174657175 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY SAJKO Presdient 757-925-1136 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: VA 0102036877) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 0101054964) |
| 207W00000X Ophthalmology (Licence: VA 0102036877) | |
| 207W00000X Ophthalmology (Licence: VA 0101054964) | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2008-01-28 |