| NPI | 1972798577 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NINA PHAM CHRISTENSEN Optometrist 262-893-4396 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: WI 2803) |
| Enumeration Date | 2007-09-07 |
| Last Update Date | 2016-01-12 |