| NPI | 1609171800 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT H PETERMANN Provider/Owner 229-249-0944 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT002187) |
| Enumeration Date | 2011-01-19 |
| Last Update Date | 2011-01-19 |