| NPI | 1619148145 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | D. PENN MOODY Member 765-342-5497 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18001808B) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2008-03-12 |
| Last Update Date | 2010-12-14 |