NPI | 1144607128 |
---|---|
Entity Type | Organization |
Authorized Contact | HERBERT WALDO FORREST O PT Ician/Owner 336-818-8733 |
Organization Subpart ? | No |
Primary Taxonomy | 332H00000X Eyewear Supplier (Licence: NC 421) |
Enumeration Date | 2015-04-29 |
Last Update Date | 2015-04-29 |