| NPI | 1184882797 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA ROBERTS DOUGLAS Credentialing 866-551-0232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA oeg000494) |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2014-09-11 |