| NPI | 1649933763 |
|---|---|
| Doing Business As | CHARLESTON VISION SOURCE |
| Entity Type | Organization |
| Authorized Contact | LAURA M SUPPA SAMMONS Optometrist 304-545-8366 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist |
| Enumeration Date | 2021-10-15 |
| Last Update Date | 2023-05-25 |