| NPI | 1952787244 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE SISKO Credentialing Specialist 727-483-7463 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: VA 0101237120) |
| Enumeration Date | 2015-08-10 |
| Last Update Date | 2015-08-10 |