| NPI | 1740645274 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GAIL TYSENN Billing Manager 954-473-4108 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: FL me25911) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: FL opc1779) |
| Enumeration Date | 2015-12-29 |
| Last Update Date | 2015-12-29 |