| NPI | 1437577749 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAGDY AZIZ KEROLLOS BEBAWY President 909-235-1998 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: CA 14579TPA) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Licence: CA 14579TPA) |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2014-04-03 |