| NPI | 1942604608 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE ELLINGSWORTH Administrator 410-660-2646 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management |
| 152WL0500X Optometrist, Low Vision Rehabilitation | |
| Enumeration Date | 2014-10-09 |
| Last Update Date | 2016-03-02 |