| NPI | 1629016381 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEAHANN RENE VAUGHN Director 470-448-2782 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2021-09-17 |