| NPI | 1528741543 |
|---|---|
| Other Name | LOCATION 1 DE |
| Entity Type | Organization |
| Authorized Contact | MELISSA K ALLISON Sr. Director Rcm/Mvc 618-462-9818 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist |
| Enumeration Date | 2023-08-08 |
| Last Update Date | 2023-08-17 |