| NPI | 1609104637 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COLLEEN MARY KING Optometrist 904-472-0084 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC3718) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC4005) |
| Enumeration Date | 2009-12-02 |
| Last Update Date | 2022-05-31 |