| NPI | 1699051193 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEAU DAVID POQUETTE Optometrist 906-774-8280 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901004595) |
| Enumeration Date | 2011-10-27 |
| Last Update Date | 2016-11-23 |