| NPI | 1508104167 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL SMITH Owner 225-751-4100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X (Licence: LA 621000) |
| Additional Taxonomies | 152W00000X Optometrist |
| 156FX1202X Technician/Technologist, Optometric Technician | |
| 156FX1800X Technician/Technologist, Optician | |
| Enumeration Date | 2013-01-16 |
| Last Update Date | 2019-09-06 |