NPI | 1205078284 |
---|---|
Entity Type | Organization |
Authorized Contact | GABRIELLE WARREN MARSHALL Owner 541-323-3937 |
Organization Subpart ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: OR 2635 ATI) |
Additional Taxonomies | 152WP0200X Optometrist Pediatrics (Licence: OR 2635 ATI) |
152WV0400X Optometrist Vision Therapy (Licence: OR 2635 ATI) | |
332H00000X Eyewear Supplier | |
Enumeration Date | 2009-04-06 |
Last Update Date | 2018-08-15 |