| NPI | 1003462763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA ELLIS President 402-613-3776 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2019-08-16 |
| Last Update Date | 2019-08-16 |