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 |