| NPI | 1417679754 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE STEWART Administrator 262-330-0410 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2022-09-14 |
| Last Update Date | 2022-09-14 |