| NPI | 1902517659 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHERRIE S MCEWEN Billing Agent/Credentialing 985-250-8300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2022-12-13 |
| Last Update Date | 2026-01-19 |