| NPI | 1790883445 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC GENE GODUCO Secretary Treasurer 423-339-9937 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Additional Taxonomies | 156FX1201X Technician/Technologist, Optometric Assistant |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2020-08-22 |