| NPI | 1669202248 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRICK VAUGHN Credentialing Specialist 410-571-8733 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology |
| Additional Taxonomies | 152W00000X Optometrist |
| Enumeration Date | 2024-08-07 |
| Last Update Date | 2024-08-07 |