| NPI | 1679290829 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH PRAVOOT GIRA Md 314-909-0633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 207W00000X Ophthalmology |
| Enumeration Date | 2022-10-27 |
| Last Update Date | 2022-10-27 |