| NPI | 1619375664 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN PITTMAN Director Of Managed Care 920-205-1991 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2014-12-08 |
| Last Update Date | 2022-05-31 |