| NPI | 1578899910 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OCTAVIA JACKSON WILLIAMS Credentialing Specialist 318-561-0946 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier |
| Additional Taxonomies | 152W00000X Optometrist |
| 207W00000X Ophthalmology | |
| Enumeration Date | 2009-10-20 |
| Last Update Date | 2022-01-19 |