| NPI | 1801215272 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN D RUSSELL Optometrist 662-844-7211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: MS 041067620) |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2014-04-14 |