| NPI | 1972191666 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY NISSINOFF CEO 321-537-9979 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 207W00000X Ophthalmology |
| Enumeration Date | 2021-01-07 |
| Last Update Date | 2021-01-07 |