| NPI | 1366863862 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER ELAM Member 855-488-3937 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3367) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: MN 3367) |
| Enumeration Date | 2013-12-31 |
| Last Update Date | 2015-02-12 |