| NPI | 1972561660 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA M BURGESS Credentialing Specialist 252-985-1371 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 207W00000X Ophthalmology |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2008-06-19 |