| NPI | 1568118545 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BETH ULRICH Owner 952-928-7005 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 332H00000X Eyewear Supplier |
| Enumeration Date | 2022-02-28 |
| Last Update Date | 2025-03-21 |