| NPI | 1336212158 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LUKE BROG President 307-883-4678 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WY 296T) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Licence: WY 296T) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2013-03-25 |