| NPI | 1992830079 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES J WACHTER Doctor 636-200-4393 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: AL S536TA063) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AL S838TA391) |
| 152W00000X Optometrist (Licence: AL SC62TA905) | |
| 152W00000X Optometrist (Licence: AL S536TA063) | |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2019-06-21 |