| NPI | 1669833166 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY ADAMS BRODERICK Managing Member 505-379-2158 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2016-03-10 |
| Last Update Date | 2022-08-30 |