| NPI | 1679634471 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLEY R ROUTH Billing Manager Front Off Super 970-243-8697 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CO 36956) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CO 2476) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2008-04-20 |