| NPI | 1578668125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OK 802) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: OK 802) |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: OK 802) | |
| 152WX0102X Optometrist, Occupational Vision (Licence: OK 802) | |
| 152WP0200X Optometrist, Pediatrics (Licence: OK 802) | |
| 152WS0006X Optometrist, Sports Vision (Licence: OK 802) | |
| 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: OK 802) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2011-11-09 |