| NPI | 1467836650 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISSY HENRY Business Office Manager 320-258-3915 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management |
| 152WL0500X Optometrist, Low Vision Rehabilitation | |
| 152WP0200X Optometrist, Pediatrics | |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2015-07-17 |