| NPI | 1497382204 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB WILLIAM LETOURNEAU Owner 785-842-1242 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management |
| 152WS0006X Optometrist Sports Vision | |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2020-03-24 |