| NPI | 1679511679 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT BRUCE WALLACE Medical Director 318-448-4488 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: LA 012846) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2020-08-22 |