| NPI | 1164791414 |
|---|---|
| Former Legal Business Name | MADRAS VISION SOURCE LLC |
| Entity Type | Organization |
| Authorized Contact | JESSICA BROOKE TEGAN Owner 541-475-2020 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR 3215ATI) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2011-12-15 |
| Last Update Date | 2022-05-17 |