| NPI | 1861519779 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WALLACE B. JOHNSTON Optician 219-923-6088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician (Licence: IN 0016898600018) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2008-07-21 |