| NPI | 1275777658 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACI RUNYON Managed Care Coordinator 540-855-3554 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: VA 09L0899) |
| Enumeration Date | 2009-04-29 |
| Last Update Date | 2016-12-15 |