| NPI | 1710353891 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY TIDSWELL Owner/O PT Ometrist 719-688-3307 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO 1184) |
| Enumeration Date | 2015-08-12 |
| Last Update Date | 2015-08-12 |