| NPI | 1831907229 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CREDENTIALING SPECIALIST Provider Credentialing Specialist 410-571-8733 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist |
| Enumeration Date | 2024-12-18 |
| Last Update Date | 2025-11-13 |