| 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 | 332H00000X Eyewear Supplier (Equipment, not the service) |
| 152WP0200X Optometrist, Pediatrics (Licence: OR 2635 ATI) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: OR 2635 ATI) | |
| Enumeration Date | 2009-04-06 |
| Last Update Date | 2018-08-15 |