| NPI | 1326458464 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORSEY HENDERSON Manager 217-698-9477 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2019-10-22 |