| NPI | 1790972453 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD A HENSEN Owner 909-627-8523 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 6686) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 6671) |
| 332H00000X Eyewear Supplier (Licence: CA 6686) | |
| 332H00000X Eyewear Supplier (Licence: CA 6671) | |
| Enumeration Date | 2007-09-26 |
| Last Update Date | 2013-05-23 |