| NPI | 1023295763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN GRONDAHL Optician/Owner 941-966-1559 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: FL 3259) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier (Licence: FL 3259) |
| Enumeration Date | 2008-01-24 |
| Last Update Date | 2008-03-24 |