| NPI | 1366786774 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY POWERS Specialist, Plan Enrollment 479-204-0709 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332H00000X Eyewear Supplier |
| Additional Taxonomies | 156FX1800X Technician/Technologist Optician |
| Enumeration Date | 2012-11-26 |
| Last Update Date | 2012-11-26 |