| NPI | 1619567054 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AARON HOLTEBECK Owner 262-393-2020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology |
| Additional Taxonomies | 152W00000X Optometrist |
| Enumeration Date | 2021-01-20 |
| Last Update Date | 2021-05-19 |