| NPI | 1700250628 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA ELAINE JUDSON Owner 812-232-1000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152WS0006X Optometrist Sports Vision (Licence: IN 18003213A) |
| Enumeration Date | 2015-11-16 |
| Last Update Date | 2020-09-01 |