| 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 |