| NPI | 1326461807 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESS E MENDENHALL Member 520-678-6567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 207W00000X Ophthalmology |
| Enumeration Date | 2014-02-04 |
| Last Update Date | 2014-04-04 |