| NPI | 1871535419 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY PEVNICK Co Owner 314-653-0918 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2015-08-25 |