| NPI | 1336584176 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY LYNN HAYNES Executive Director 386-917-1001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC1293) |
| Enumeration Date | 2013-05-07 |
| Last Update Date | 2016-06-06 |