| NPI | 1689630832 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY JOHN CORBRIDGE Owner/ President 928-757-5005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 829) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2008-05-12 |