| NPI | 1477680015 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PENNY JACKSON Credentialing 517-202-1618 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901002974) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MI 4901004286) |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2026-05-08 |