Organization
DHP RETAIL ENTITY, LLC
Active
Other names
My Eye Lab
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE BENNETT (CREDENTIALING MANAGER)
(561) 433-6009
Entity
Organization
Contact information
Practice address
1680 CAMPBELL LN STE 104, BOWLING GREEN, KY 42104-1062
(561) 275-2020
Mailing address
431 PREAKNESS WAY, BOWLING GREEN, KY 42104-8563
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
01/31/2019
Last updated
01/31/2019
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