| NPI | 1780779835 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNA LOUISE GONGOLA President Optometrist 304-636-3887 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WV WV93800) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2008-04-02 |