| 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 |