| NPI | 1629254107 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL O RUSSELL Provider 843-662-3278 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: SC 601) |
| Enumeration Date | 2008-01-15 |
| Last Update Date | 2011-07-22 |