| NPI | 1619972734 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID G. GAUSTAD Owner/Manager 218-998-2020 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Additional Taxonomies | 156FX1800X Technician/Technologist, Optician |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2009-07-13 |