| NPI | 1073917092 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLINE DIANE HENNING Clinical Director 605-237-0562 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Additional Taxonomies | 152W00000X Optometrist |
| 156FX1800X Technician/Technologist, Optician | |
| Enumeration Date | 2014-10-20 |
| Last Update Date | 2015-03-19 |