| NPI | 1326538224 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACI E RUNYON Managed Care 540-855-3554 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2020-03-30 |