| NPI | 1508874371 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACI E RUNYON Managed Care COO Rdinator 540-855-5139 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2020-08-22 |