| NPI | 1578022588 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE JORGENSEN Practice Administrator 920-593-5724 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2025-06-24 |