| NPI | 1043494933 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WES G CRAINSHAW O PT Ical Provider Enrollment 479-277-1850 |
| Organization Subpart ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist Optician |
| Additional Taxonomies | 332H00000X Eyewear Supplier |
| Enumeration Date | 2007-12-27 |
| Last Update Date | 2007-12-27 |