NPI | 1104374420 |
---|---|
Entity Type | Organization |
Authorized Contact | LAURA LEVINE Dir Healthcare Contract & Enroll 479-204-8550 |
Organization Subpart ? | Yes |
Primary Taxonomy | 332H00000X Eyewear Supplier |
Additional Taxonomies | 156FX1800X Technician/Technologist Optician |
Enumeration Date | 2016-09-15 |
Last Update Date | 2017-01-04 |