| NPI | 1710172176 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WARREN PAUL WISE Od 843-525-9473 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 1051) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC 1031) |
| Enumeration Date | 2007-09-10 |
| Last Update Date | 2010-12-02 |