| NPI | 1114860624 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALISHA JACKSON Managed Care Manager 561-208-1591 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2026-04-10 |
| Last Update Date | 2026-04-10 |