| NPI | 1790348449 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRITTANY N. CAPSTICK Dr. 612-308-0679 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management |
| 152WP0200X Optometrist, Pediatrics | |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2019-04-30 |