| NPI | 1437474855 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA CLYDE CANTRELL Executive Member 816-550-3937 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO MO200300960) |
| Enumeration Date | 2010-03-29 |
| Last Update Date | 2010-03-29 |