| NPI | 1891582482 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRAVIS WRYE Controller 815-263-2190 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2025-04-24 |
| Last Update Date | 2025-04-24 |