| NPI | 1942570874 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BERNETTA DAVIS-POOLE Resident Agent 410-523-1224 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA0696) |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2013-03-31 |