| NPI | 1871613554 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBIN J. MADDOX Provider Enrollment COO Rdinator 912-350-9335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 207W00000X Ophthalmology |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2008-08-13 |