| NPI | 1225100399 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT EDWARD TITCOMB Optometrist 757-460-3688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 06180000523) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: VA 0618000523) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2010-12-17 |