| NPI | 1225619786 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND BANNAN Owner 740-676-1121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology |
| Additional Taxonomies | 152W00000X Optometrist |
| Enumeration Date | 2021-04-16 |
| Last Update Date | 2021-04-16 |