| NPI | 1548297070 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FREDERICK ELLISON CONRAD Owner 276-628-9141 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101021147) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: VA 0101021147) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2020-08-22 |