| NPI | 1720179104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIETRICH ALBERT FELLNER President 757-490-9091 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101232452) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618000757) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2008-05-20 |