NPI | 1770335085 |
---|---|
Doing Business As | ELK GROVE OPTICAL |
Entity Type | Organization |
Authorized Contact | MELISSA ALLISON Sr. Director Mvc 618-462-9818 |
Organization Subpart ? | Yes |
Primary Taxonomy | 152W00000X Optometrist |
Enumeration Date | 2024-04-02 |
Last Update Date | 2024-04-02 |