NPI | 1104296607 |
---|---|
Entity Type | Organization |
Authorized Contact | OCTAVIA JACKSON WILLIAMS Credentialing Specialist 318-561-0946 |
Organization Subpart ? | No |
Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
Enumeration Date | 2015-09-28 |
Last Update Date | 2022-01-19 |