| NPI | 1184719387 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH RICHARD DAVENPORT President 843-871-9750 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC 589) |
| 156FX1800X Technician/Technologist, Optician (Licence: SC 686) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2023-08-07 |