| NPI | 1215138771 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS EARL GUSTAFSON President 847-638-7308 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046008241) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2020-03-13 |