| NPI | 1932440138 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEIGH TACKETT Clinic Coordinator 662-647-8707 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MS 722) |
| Enumeration Date | 2013-03-13 |
| Last Update Date | 2021-02-01 |