| NPI | 1235553157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | C WATT TATE President 706-322-5528 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Licence: GA OPT002724) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT002724) |
| Enumeration Date | 2014-02-12 |
| Last Update Date | 2014-02-27 |