| NPI | 1558629584 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NGOC AU Optometrist 267-471-6245 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: PA 4101203) |
| Additional Taxonomies | 152W00000X Optometrist |
| Enumeration Date | 2012-04-27 |
| Last Update Date | 2026-01-11 |