| NPI | 1114144276 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARREN THOMAS HORNDASCH President 262-432-2005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2022-08-22 |