| NPI | 1609877083 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLEY RENEE GAST Controller 812-258-3026 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: IN 01025213) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: KY 15811) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2020-08-22 |