| NPI | 1689794794 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL LEE HEDLUND Owner 814-868-0895 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG000644) |
| 152W00000X Optometrist | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2008-02-21 |