| NPI | 1063697514 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHON JAMES CUCKLER Optician/Manager 970-356-1047 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: CO 12-43937-0000) |
| Enumeration Date | 2008-01-03 |
| Last Update Date | 2008-01-03 |