| NPI | 1407876840 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY PANTEL Billing Supervisor 920-803-3266 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2023-10-03 |