NPI | 1962456343 |
---|---|
Entity Type | Organization |
Authorized Contact | PAMELA A MADISON Credentialing Manager 910-484-2284 |
Organization Subpart ? | No |
Primary Taxonomy | 207W00000X Ophthalmology |
Additional Taxonomies | 152W00000X Optometrist |
152WP0200X Optometrist, Pediatrics | |
Enumeration Date | 2006-05-20 |
Last Update Date | 2012-04-25 |