| NPI | 1740758366 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOLLY RAE BOHANNAN Owner 479-530-6649 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0132X Clinic/Center Ophthalmologic Surgery |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2018-11-13 |