| NPI | 1437164175 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY DEBRUIN Billing Department Manager 920-751-8666 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2023-08-29 |