| NPI | 1992167407 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FRANK ANTHONY BROOME Owner 386-466-1062 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: FL 1992167407) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL 1679554760) |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2016-09-09 |