NPI | 1346479284 |
---|---|
Entity Type | Organization |
Authorized Contact | DAVID A. FULLENKAMP President 260-726-5161 |
Organization Subpart ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18002167A) |
Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: IN 18002167A) |
Enumeration Date | 2009-07-14 |
Last Update Date | 2010-05-13 |