| NPI | 1376272047 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA HAGEN Practice Manager 920-593-5700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Additional Taxonomies | 152W00000X Optometrist |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2022-06-08 |