| NPI | 1851757678 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACLYN MUNSON Owner/Manager 815-735-1175 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 152WV0400X Optometrist Vision Therapy (Licence: CO 3174) |
| Enumeration Date | 2016-01-08 |
| Last Update Date | 2016-07-12 |