| 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 |