| NPI | 1376986539 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVORY AMELIA KINSLOW Owner 870-862-2340 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: AR C7743) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AR 2574) |
| Enumeration Date | 2013-04-08 |
| Last Update Date | 2018-05-16 |