| NPI | 1477235752 |
|---|---|
| Former Legal Business Name | CHANEL FORD OPTICS LLC |
| Entity Type | Organization |
| Authorized Contact | SHELLNELL PETTIFORD Supervisor 754-224-0594 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Enumeration Date | 2023-08-04 |
| Last Update Date | 2023-08-04 |