| NPI | 1548937402 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY K LUTTRULL Owner 424-303-7394 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology, Retina Specialist |
| Additional Taxonomies | 207W00000X Ophthalmology |
| Enumeration Date | 2021-08-26 |
| Last Update Date | 2022-06-14 |