| NPI | 1316009368 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH B GUM Doctor 231-935-8101 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology |
| Additional Taxonomies | 152W00000X Optometrist |
| 332H00000X Eyewear Supplier (Equipment, not the service) | |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2021-03-30 |