| NPI | 1912142241 |
|---|---|
| Other Name | GALLUP VISION SOURCE |
| Entity Type | Organization |
| Authorized Contact | MICHAEL G BLAKE O PT Ometrist 505-722-2020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Enumeration Date | 2008-12-16 |
| Last Update Date | 2008-12-16 |