| NPI | 1831259761 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY ALLEN JORGENSEN Optician Hearing Aid Dispenser 563-386-8170 |
| Organization Subpart ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) |
| 332S00000X Hearing Aid Equipment (Licence: IA 183) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2007-12-28 |