| NPI | 1902580459 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL PETRO Optometrist 317-418-6170 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2023-06-14 |
| Last Update Date | 2023-09-07 |