| NPI | 1205874252 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARITA LAWSON Provider Network Administrator 800-571-5202 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2010-05-10 |