| NPI | 1508986167 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER WENTWORTH Ophthalmologist 270-780-0594 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Licence: KY 102090) |
| Additional Taxonomies | 156FX1100X Technician/Technologist Ophthalmic (Licence: KY E82360) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2008-05-07 |