| NPI | 1235210147 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD L. STOUT President 765-362-8606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18001770A) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IN 18002826A) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2010-01-05 |