| NPI | 1629596200 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA JISELLE BLADE O PT Ometrist/Owner 407-217-7375 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC5035) |
| Additional Taxonomies | 152WS0006X Optometrist Sports Vision (Licence: FL OPC5035) |
| 152WV0400X Optometrist Vision Therapy (Licence: FL OPC5035) | |
| Enumeration Date | 2017-09-05 |
| Last Update Date | 2018-01-03 |