NPI | 1508889866 |
---|---|
Entity Type | Organization |
Authorized Contact | RYAN LYNN VON HOLTEN President/Optometrist 815-922-3545 |
Organization Subpart ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046009558) |
Enumeration Date | 2006-07-26 |
Last Update Date | 2013-12-12 |