| NPI | 1255600763 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN HEINTZ Owner 541-757-8844 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR 2515T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OR 3307ATI) |
| 332H00000X Eyewear Supplier | |
| Enumeration Date | 2011-12-29 |
| Last Update Date | 2019-08-12 |