| NPI | 1922768688 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOLSIE MCDONALD Credentialing Manager 210-524-6663 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2021-12-22 |
| Last Update Date | 2021-12-22 |