| NPI | 1861803520 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWIN KYLE MITCHELL Owner 336-707-6542 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 1696) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: SC 1696) |
| 152WP0200X Optometrist, Pediatrics (Licence: SC 1696) | |
| Enumeration Date | 2014-05-15 |
| Last Update Date | 2015-09-11 |