| NPI | 1255008868 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS A PETERSEN Member/Manager 801-362-0599 |
| 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 | 2024-02-26 |