| NPI | 1518912401 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANNA PURCELL Providre Network Administrator 770-822-4245 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2008-06-16 |