| NPI | 1215101126 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY C. VELOSO Doctor/Owner 540-342-6294 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: VA 0618001002) |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site (Licence: VA 0618001002) |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2008-08-15 |