| NPI | 1306218995 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUDY CHANTHALANGSY O PT Ometrist/Owner 815-997-0164 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3326) |
| Enumeration Date | 2015-10-22 |
| Last Update Date | 2015-10-22 |