| NPI | 1225564420 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANA MILLER Credentialing COO Rdinator 317-254-6480 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18001899) |
| Enumeration Date | 2017-05-08 |
| Last Update Date | 2017-05-08 |