| NPI | 1902074586 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BONNIE L CULFA Division Of Health Director 906-632-5200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2008-05-30 |