| NPI | 1861938524 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BLAKE GORDON POWELL Owner/O PT Ometrist 419-698-4949 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 6309/T3225) |
| Enumeration Date | 2017-01-18 |
| Last Update Date | 2017-03-28 |