| NPI | 1609828870 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DALE JOHNSON Manager 906-632-2020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152WV0400X Optometrist, Vision Therapy (Licence: MI 4901002749) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2015-07-29 |