| NPI | 1952323990 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBIN J. MADDOX Provider Enrollment Coordinator 912-350-9335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology |
| Additional Taxonomies | 152W00000X Optometrist |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2008-01-09 |