| NPI | 1629100011 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DALE W MUTH Optometrist 906-293-9276 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: MI 4901003944) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2015-06-09 |