| NPI | 1700334794 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TONI WYNN RACOMA Managing Member 609-312-1115 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 8129TG) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: TX 8129TG) |
| 152WL0500X Optometrist Low Vision Rehabilitation (Licence: TX 8129TG) | |
| 152WP0200X Optometrist Pediatrics (Licence: TX 8129TG) | |
| 152WS0006X Optometrist Sports Vision (Licence: TX 8129TG) | |
| 152WV0400X Optometrist Vision Therapy (Licence: TX 8129TG) | |
| 152WX0102X Optometrist Occupational Vision (Licence: TX 8129TG) | |
| Enumeration Date | 2016-09-19 |
| Last Update Date | 2016-12-29 |