| NPI | 1053615708 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DALE J MOSER Owner 989-386-2020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901003085) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: MI 003085) |
| 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: MI 004640) | |
| Enumeration Date | 2011-01-10 |
| Last Update Date | 2012-04-03 |