| NPI | 1689077471 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY R HUMES Owner 313-316-0120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901004672) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MI 4901003785) |
| Enumeration Date | 2014-10-07 |
| Last Update Date | 2014-10-07 |