| NPI | 1962973503 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENIFER PANKOW Administrator 708-704-1890 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management |
| Additional Taxonomies | 152W00000X Optometrist |
| Enumeration Date | 2018-12-07 |
| Last Update Date | 2025-05-02 |