| NPI | 1255055646 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN KONYNENBELT Member 616-834-2598 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management |
| 152WP0200X Optometrist, Pediatrics | |
| 152WS0006X Optometrist, Sports Vision | |
| 152WV0400X Optometrist, Vision Therapy | |
| Enumeration Date | 2022-09-28 |
| Last Update Date | 2022-09-28 |