1162 Military Trail LLC
NPI #1750638755 in Santa Rosa Beach, Florida
Provider Information
- NPI Number
- 1750638755
- Entity Type
- Organization
- Organization Name
- 1162 Military Trail LLC
- Primary Specialty
- Technician/Technologist - Optician
- Enumeration Date
- Aug 8, 2012
- Last Updated
- Aug 8, 2012
Practice Location
- Address
- 25 CENTRAL SQUARE
- City
- Santa Rosa Beach
- State
- Florida
- ZIP Code
- 32459
- Phone
- (888) 264-4989
Authorized Official
- Name
- DR. GALEN GRAYSON, M.D.
- Title
- OWNER/MEDICAL DIRECTOR
- Phone
- (704) 295-0001
Specialties & Taxonomy Codes
| Specialty |
|---|
| Technician/Technologist - Optician — Optician |
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