| NPI | 1982093563 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD ALLEN BRAKE President 336-766-6680 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 1384) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: NC 1384) |
| Enumeration Date | 2015-01-20 |
| Last Update Date | 2015-01-20 |