| NPI | 1669152435 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MUHANNAH S KAKISH President 763-843-4262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 156F00000X Technician/Technologist |
| 332H00000X Eyewear Supplier (Equipment, not the service) | |
| Enumeration Date | 2023-07-18 |
| Last Update Date | 2023-07-18 |