| NPI | 1659370526 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAYLEE LIZABETH DOUGHERTY President 800-824-2492 |
| Organization Subpart ? | No |
| Primary Taxonomy | 229N00000X Anaplastologist |
| Additional Taxonomies | 156FX1700X Technician/Technologist, Ocularist |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: ME no license required) | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2020-05-06 |