| NPI | 1871763862 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAYNE DOUGHERTY Owner Optician 304-232-6501 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: WV 0507000045) |
| Additional Taxonomies | 156FX1800X Technician/Technologist, Optician (Licence: WV 05 7 00045) |
| Enumeration Date | 2008-03-05 |
| Last Update Date | 2008-03-05 |