| NPI | 1790978575 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEDRO JOSEPH BRODEUR Optometrist 573-437-8004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: MO TO2435) |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2013-02-21 |