| 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 |