| NPI | 1457759144 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL JOHNSON Owner 313-544-6778 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2014-12-11 |
| Last Update Date | 2015-07-22 |