| NPI | 1225425044 |
|---|---|
| Former Legal Business Name | CO OP OPTICAL CENTER |
| Entity Type | Organization |
| Authorized Contact | CATHY L SHORT Credentialing Manager 618-462-9818 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2015-04-20 |
| Last Update Date | 2018-06-27 |