| NPI | 1417200148 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHY HEGAN Practice Administrator 912-629-5929 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 207W00000X Ophthalmology |
| Enumeration Date | 2012-10-18 |
| Last Update Date | 2012-10-18 |