| NPI | 1629104674 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | L.D. IAN ROE Managing Member 863-382-7300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology |
| Additional Taxonomies | 152W00000X Optometrist |
| 156FX1800X Technician/Technologist, Optician | |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2008-12-30 |