| NPI | 1265943450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TABITHA JOHNSON Owner 864-540-8404 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152WV0400X Optometrist Vision Therapy |
| Additional Taxonomies | 152W00000X Optometrist |
| Enumeration Date | 2017-10-16 |
| Last Update Date | 2017-10-16 |