| NPI | 1619507886 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKIE BENNETT Credentialing Supervisor 561-433-6009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 332H00000X Eyewear Supplier |
| Enumeration Date | 2020-01-16 |
| Last Update Date | 2021-02-19 |