| NPI | 1568107670 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STANLEY FULLER Owner 907-479-2020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology |
| Additional Taxonomies | 152W00000X Optometrist |
| 156FX1800X Technician/Technologist, Optician | |
| Enumeration Date | 2022-05-03 |
| Last Update Date | 2022-07-22 |