| NPI | 1124895065 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW MCMULLIN Director 479-371-8711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist Optician |
| Additional Taxonomies | 332H00000X Eyewear Supplier |
| Enumeration Date | 2023-12-11 |
| Last Update Date | 2023-12-11 |