| NPI | 1265552889 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN WIEBOLD Optician 352-367-0077 |
| Organization Subpart ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician (Licence: FL OE 1592) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2020-08-22 |