| NPI | 1619949971 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH PRAVOOT GIRA Owner 314-909-0633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207WX0107X Ophthalmology Retina Specialist |
| Additional Taxonomies | 152WL0500X Optometrist Low Vision Rehabilitation (Licence: KY 1689DT) |
| 207W00000X Ophthalmology | |
| 152W00000X Optometrist | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2024-10-30 |