| NPI | 1942580428 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL GARDNER Sole Managing Member 770-707-0711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT002401) |
| Enumeration Date | 2011-08-28 |
| Last Update Date | 2011-08-28 |