| NPI | 1689107062 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA N HICKMAN Owner 985-231-0800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 261Q00000X (Licence: LA 1603-636AT) |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2023-08-14 |