| NPI | 1679558712 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI A WIRTH General Manager 231-941-7788 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2012-05-10 |