| NPI | 1497818660 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BJ RICE Provider Enrollment Specialist 479-277-9835 |
| Organization Subpart ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist Optician |
| Additional Taxonomies | 332H00000X Eyewear Supplier |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2020-08-22 |