| NPI | 1417721713 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA YSEN Owner/O PT Ician 218-283-2525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2023-11-08 |
| Last Update Date | 2023-11-08 |