| NPI | 1306194394 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL K JACOBSON Physician 509-456-0107 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Licence: WA 602617024) |
| Enumeration Date | 2012-08-22 |
| Last Update Date | 2012-08-22 |