| NPI | 1811166135 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID KOCH Owner 937-667-6914 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH 55031434) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: OH 55031434) |
| Enumeration Date | 2008-02-21 |
| Last Update Date | 2013-06-21 |