| NPI | 1922104660 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLYN M BALOG President 574-546-3820 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IN 18001983A) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: IN 18001983A) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2008-01-22 |