| NPI | 1639775117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKIE BENNETT Credentialing Manager 561-612-4531 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2020-12-09 |
| Last Update Date | 2021-02-19 |