| NPI | 1952541955 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CATHY L SHORT Credentialing Manager 618-462-9818 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OE006128p) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: PA 6000002687) |
| Enumeration Date | 2009-03-03 |
| Last Update Date | 2020-07-15 |