| NPI | 1508900879 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAT BLACK Insurance Manager 706-692-2878 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2008-06-24 |