| NPI | 1578800371 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIELLE SMITH Enrollment Specialist 479-204-8705 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332H00000X Eyewear Supplier |
| Additional Taxonomies | 156FX1800X Technician/Technologist Optician |
| Enumeration Date | 2013-01-14 |
| Last Update Date | 2013-01-14 |