NPI | 1669444063 |
---|---|
Entity Type | Organization |
Authorized Contact | MARIE ANNETTE MANGRUM Board Secretary/Treas. 618-466-8787 |
Organization Subpart ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: IL 22652655) |
Enumeration Date | 2006-02-02 |
Last Update Date | 2011-08-29 |