| NPI | 1346538113 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRI JOHNSON Consultant 321-956-0485 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC1767) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: FL OPC1767) |
| Enumeration Date | 2011-07-14 |
| Last Update Date | 2011-10-21 |