| NPI | 1558602771 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACQUELINE J STACK Director Of Billing 774-320-3040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology |
| Additional Taxonomies | 152W00000X Optometrist |
| Enumeration Date | 2013-03-13 |
| Last Update Date | 2023-07-26 |