| NPI | 1568118545 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHRYN LOUISE PROKOSCH Credentialing/Biller 651-465-4306 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2022-02-28 |
| Last Update Date | 2024-07-25 |