NPI | 1235550146 |
---|---|
Doing Business As | BLACK ROCK VISION CENTER |
Entity Type | Organization |
Authorized Contact | BRANT MICHAEL SOUTHAM Owner/President 775-825-0559 |
Organization Subpart ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: NV 779) |
Enumeration Date | 2013-12-18 |
Last Update Date | 2013-12-18 |