| NPI | 1225153455 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAUDE LUCILLE HOUGH Owner 352-377-0532 |
| Organization Subpart ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist Optician (Licence: FL 5019) |
| Additional Taxonomies | 332H00000X Eyewear Supplier |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2008-10-28 |