| NPI | 1720786775 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREN JOE BAILEY Owner 469-999-2747 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152WL0500X Optometrist, Low Vision Rehabilitation |
| Additional Taxonomies | 152WS0006X Optometrist, Sports Vision |
| 152W00000X Optometrist | |
| Enumeration Date | 2023-02-20 |
| Last Update Date | 2023-02-20 |