| NPI | 1437320405 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA LYNN DECKER O PT Ical Store Manager 225-262-8141 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: LA 6872006003) |
| Enumeration Date | 2008-03-18 |
| Last Update Date | 2008-03-18 |