| NPI | 1295715415 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC M LARSON President 920-232-6550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology |
| Additional Taxonomies | 152W00000X Optometrist |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2024-01-16 |