| NPI | 1508920406 |
|---|---|
| Doing Business As | VISION CENTER 30-4224 |
| Entity Type | Organization |
| Authorized Contact | DAVID J. SIMMONS Provider Enrollment Specialist 479-277-9373 |
| Organization Subpart ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2007-09-13 |