| NPI | 1386991271 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AYESHA C KIDD O PT Ometrist/Member 251-645-2991 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL S-C61-TA-904) |
| Enumeration Date | 2012-08-09 |
| Last Update Date | 2012-08-09 |