| NPI | 1346498409 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK CRAWFORD WADE Managing Member 920-735-9580 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WI 2210) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WI 2226) |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2022-09-22 |