| NPI | 1699974980 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SALLY JILOT Administrator 920-965-4800 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology |
| Additional Taxonomies | 152W00000X Optometrist |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2020-05-29 |