| NPI | 1699979211 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL JACOB SUSCAVAGE Managing Member 215-368-4660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG001503) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2008-06-30 |