| NPI | 1538765888 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURIE REEDHUDSON Credentialing Specialist 726-444-4148 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2020-12-10 |
| Last Update Date | 2021-12-15 |