| NPI | 1780244962 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKIE BENNETT Credentialing Manager 561-612-4531 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 332H00000X Eyewear Supplier |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2021-02-17 |