| NPI | 1235539099 |
|---|---|
| Doing Business As | BROAD STREET VISION CENTER |
| Entity Type | Organization |
| Authorized Contact | FRED S CLONINGER Owner 7041-865-3731 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: NC 0804) |
| Enumeration Date | 2014-08-29 |
| Last Update Date | 2014-08-29 |