| NPI | 1366697799 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER TERRELL BULLIN Owner 601-366-9020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MS 783) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: MS 783) |
| Enumeration Date | 2008-11-26 |
| Last Update Date | 2016-12-08 |