| NPI | 1801987367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY TROST Pres O PT Ician 815-933-5798 |
| Organization Subpart ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist Optician |
| Additional Taxonomies | 156F00000X Technician/Technologist |
| 156FC0800X Technician/Technologist Contact Lens | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2013-07-03 |