| NPI | 1528237690 |
|---|---|
| Doing Business As | OLD TOWN OPTICAL |
| Entity Type | Organization |
| Authorized Contact | BERNARD JEFFREY PULK CEO 231-946-0333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901004124) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MI 4901004124) |
| 152WS0006X Optometrist, Sports Vision (Licence: MI 4901004124) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: MI 4901004124) | |
| Enumeration Date | 2008-02-22 |
| Last Update Date | 2008-02-22 |