| NPI | 1487915831 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GINGER KEEN Manager 601-261-2467 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MS 470) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MS 826) |
| Enumeration Date | 2012-06-01 |
| Last Update Date | 2012-06-01 |