| NPI | 1255008868 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAR PETERSEN Practice Administrator 833-208-9009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 156FX1700X Technician/Technologist, Ocularist |
| Enumeration Date | 2021-08-23 |
| Last Update Date | 2025-08-26 |