| NPI | 1396887550 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARL DAVID DODSON Owner 740-454-8581 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 3066) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: OH 3066) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2012-10-08 |