| NPI | 1396960415 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA RENEE NICHOLS Practice Manager 941-794-2020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: FL DO1765) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2008-05-08 |