| NPI | 1104545300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOLSIE MCDONALD Credentialing Manager 726-444-4078 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2022-08-23 |
| Last Update Date | 2022-08-23 |