| NPI | 1699789032 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEAN MARIE JACOBS Business Manager 920-749-4058 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 207W00000X Ophthalmology |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2021-07-09 |