| NPI | 1104585835 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL GARZA Managed Care Director 561-720-6423 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier |
| Additional Taxonomies | 152W00000X Optometrist |
| Enumeration Date | 2021-12-09 |
| Last Update Date | 2021-12-09 |