| NPI | 1639290505 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WADE GODSHALL Optometrist 816-228-1414 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO T03377) |
| Additional Taxonomies | 156FX1800X Technician/Technologist, Optician (Licence: MO 557) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2016-01-27 |