| NPI | 1154933877 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKIE BENNETT Credentialing Manager 619-357-6146 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2020-08-24 |
| Last Update Date | 2021-02-19 |