| NPI | 1912068925 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLAYTON EVERETT COBB Owner O PT Ician 860-599-3882 |
| Organization Subpart ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist Optician |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2020-08-22 |