| NPI | 1821287335 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL DAWN FULLER Practice Administrator 502-536-0156 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY KY1357DT) |
| Enumeration Date | 2007-10-21 |
| Last Update Date | 2024-11-06 |