| NPI | 1215228085 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATTY WOERMAN Credentialing Specialist 217-222-6550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2011-04-27 |