| NPI | 1215157367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER GROCHOWALSKI Administration 231-929-3888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Additional Taxonomies | 152W00000X Optometrist |
| Enumeration Date | 2007-04-30 |
| Last Update Date | 2009-11-30 |