| NPI | 1316249824 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY E GOBERVILLE Pres/O PT Ometrist 954-344-3937 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC2575) |
| Additional Taxonomies | 152WP0200X Optometrist Pediatrics (Licence: FM OPC2575) |
| 152WS0006X Optometrist Sports Vision (Licence: FL OPC2575) | |
| 152WV0400X Optometrist Vision Therapy (Licence: FL OPC2575) | |
| Enumeration Date | 2010-12-03 |
| Last Update Date | 2012-02-06 |