| NPI | 1285804286 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAROD LANCE MCCULLOUGH Owner/O PT Ometrist 636-937-3130 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO 2002014341) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2008-03-05 |
| Last Update Date | 2012-07-05 |