| NPI | 1699760900 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARYL DEMONBREUN Administrator 931-393-2020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 207W00000X Ophthalmology |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2012-10-16 |