| NPI | 1376787226 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY SHEPARD President 803-640-0116 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 1012) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: SC 1012) |
| Enumeration Date | 2009-04-22 |
| Last Update Date | 2009-05-19 |