| NPI | 1275908642 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BONNIE J ASHLEY President, O PT Ician 424-202-5415 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: CA D70648) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Licence: CA SL40477) |
| 332H00000X Eyewear Supplier (Licence: CA CL8116) | |
| 332H00000X Eyewear Supplier (Licence: CA D70648) | |
| 335E00000X Prosthetic/Orthotic Supplier (Licence: CA CL8116) | |
| 335E00000X Prosthetic/Orthotic Supplier (Licence: CA SL40477) | |
| Enumeration Date | 2015-12-10 |
| Last Update Date | 2017-05-01 |