| NPI | 1942611199 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY WAKE Owner 310-324-8205 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA 5790T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 5790T) |
| Enumeration Date | 2014-05-09 |
| Last Update Date | 2014-09-23 |