| NPI | 1760882666 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURA LEVINE Dir. Healthcare Contracting 479-204-8550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier |
| Additional Taxonomies | 156FX1800X Technician/Technologist Optician |
| Enumeration Date | 2014-08-27 |
| Last Update Date | 2014-08-27 |