| NPI | 1265128037 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACI E RUNYON Managed Care Coordinator 540-855-3554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2023-04-14 |
| Last Update Date | 2023-04-14 |