| NPI | 1043404346 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA BRUNDIES Optician 815-899-2020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2007-08-29 |