| NPI | 1558352013 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT KELLY Authorized Official 508-730-2020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology |
| Additional Taxonomies | 152W00000X Optometrist |
| 332H00000X Eyewear Supplier | |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2023-11-07 |