| NPI | 1215933510 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BARBARA RENEE BAILEY Practice Manager 642-220-0737 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology |
| Additional Taxonomies | 152W00000X Optometrist |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2018-04-20 |