| NPI | 1891770020 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY J KROUT Office Manager 864-654-4141 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 1040) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD 73286) |
| 152W00000X Optometrist (Licence: CT 002217) | |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2023-01-26 |