| NPI | 1265447973 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSS STONER Practice Administrator 419-334-8121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2009-03-19 |